Healthcare Provider Details

I. General information

NPI: 1467172247
Provider Name (Legal Business Name): CENTURIAN ANESTHESIA MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6241 ARC WAY
FORT MYERS FL
33966-1352
US

IV. Provider business mailing address

6241 ARC WAY
FORT MYERS FL
33966-1352
US

V. Phone/Fax

Practice location:
  • Phone: 239-278-7405
  • Fax:
Mailing address:
  • Phone: 239-278-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS SEAN DIGBY
Title or Position: PRESIDENT
Credential: CRNA
Phone: 239-278-9955