Healthcare Provider Details
I. General information
NPI: 1790194306
Provider Name (Legal Business Name): LORVEN ANESTHESIA,LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3256 S PINE AVE
OCALA FL
34471-6618
US
IV. Provider business mailing address
3256 S PINE AVE
OCALA FL
34471-6618
US
V. Phone/Fax
- Phone: 352-401-1919
- Fax: 352-401-1870
- Phone: 352-401-1919
- Fax: 352-401-1870
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
VISHNU
PATLOLA
REDDY
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 352-401-1919