Healthcare Provider Details

I. General information

NPI: 1396992806
Provider Name (Legal Business Name): ANESTHESIA & DISASTER MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11103 SUN TREE RD
HUDSON FL
34667-5541
US

IV. Provider business mailing address

11103 SUN TREE RD
HUDSON FL
34667-5541
US

V. Phone/Fax

Practice location:
  • Phone: 863-471-1413
  • Fax: 863-471-1416
Mailing address:
  • Phone: 863-471-1413
  • Fax: 863-471-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberARNP 1422382
License Number StateFL

VIII. Authorized Official

Name: MR. RONALD A WEGNER
Title or Position: PRESIDENT
Credential: CRNA
Phone: 863-471-1413