Healthcare Provider Details

I. General information

NPI: 1700033537
Provider Name (Legal Business Name): OUTPATIENT ANESTHESIA SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7152 COCA SABAL LN
FORT MYERS FL
33908-4263
US

IV. Provider business mailing address

7152 COCA SABAL LN
FORT MYERS FL
33908-4263
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-9939
  • Fax:
Mailing address:
  • Phone: 239-939-9939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES W PENUEL JR.
Title or Position: MANAGING PARNTER
Credential: MD
Phone: 239-939-9939