Healthcare Provider Details

I. General information

NPI: 1235434275
Provider Name (Legal Business Name): PALMETTO ANESTHESIA SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST
HIALEAH FL
33016-1801
US

IV. Provider business mailing address

PO BOX 637225
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-5000
  • Fax:
Mailing address:
  • Phone: 770-688-3809
  • 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: STEPHEN HOLTCLAW
Title or Position: OWNER
Credential: MD
Phone: 770-688-3809