Healthcare Provider Details

I. General information

NPI: 1548976525
Provider Name (Legal Business Name): CRYSTAL RIVER ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 E FOREST DR
INVERNESS FL
34453-0787
US

IV. Provider business mailing address

PO BOX 739570
DALLAS TX
75373-9568
US

V. Phone/Fax

Practice location:
  • Phone: 352-637-2787
  • Fax:
Mailing address:
  • Phone: 425-803-3885
  • 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: JEFF PERRY
Title or Position: VP REVENUE CYCLE MANAGEMENT
Credential:
Phone: 502-418-4700