Healthcare Provider Details

I. General information

NPI: 1295789956
Provider Name (Legal Business Name): MORTON PLANT MEASE OUTPATIENT ANESTHESIOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 MADISON ST BOX 803
NEW PORT RICHEY FL
34652-1971
US

IV. Provider business mailing address

PO BOX 198668
ATLANTA GA
30384-8668
US

V. Phone/Fax

Practice location:
  • Phone: 772-842-8468
  • Fax: 844-876-0873
Mailing address:
  • Phone: 855-496-3580
  • Fax: 855-371-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. PAUL GUBBINI
Title or Position: PROVIDER RELATIONS
Credential: MD
Phone: 317-614-9863