Healthcare Provider Details

I. General information

NPI: 1437718392
Provider Name (Legal Business Name): CRYSTAL RIVER ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6412 W GULF TO LAKE HWY
CRYSTAL RIVER FL
34429-7622
US

IV. Provider business mailing address

PO BOX 739570
DALLAS TX
75373-9570
US

V. Phone/Fax

Practice location:
  • Phone: 352-400-4459
  • Fax:
Mailing address:
  • Phone: 425-803-3885
  • Fax: 866-665-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JEFF PERRY
Title or Position: VP OF RCM
Credential:
Phone: 502-418-4700