Healthcare Provider Details

I. General information

NPI: 1659670453
Provider Name (Legal Business Name): ANESTHESIA SERVICES GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 MAR WALT DR
FORT WALTON BEACH FL
32547-6758
US

IV. Provider business mailing address

PO BOX 162225
ALTAMONTE SPRINGS FL
32716-2225
US

V. Phone/Fax

Practice location:
  • Phone: 850-863-7887
  • Fax: 850-863-9455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SEAN SINGH
Title or Position: CEO
Credential:
Phone: 941-360-1566