Healthcare Provider Details

I. General information

NPI: 1700459484
Provider Name (Legal Business Name): BAY AREA ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 W BAY DR
LARGO FL
33770-3225
US

IV. Provider business mailing address

PO BOX 743617
ATLANTA GA
30374-3617
US

V. Phone/Fax

Practice location:
  • Phone: 877-328-1119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN VAUGHN
Title or Position: OFFICER
Credential:
Phone: 404-450-4684