Healthcare Provider Details

I. General information

NPI: 1467799478
Provider Name (Legal Business Name): OCALA ANESTHESIA SEVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 SW 1ST AVE
OCALA FL
34471-6500
US

IV. Provider business mailing address

1431 SW 1ST AVE
OCALA FL
34471-6500
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1414
  • Fax:
Mailing address:
  • Phone: 352-401-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberRN 9352733
License Number StateFL

VIII. Authorized Official

Name: MRS. HEATHER B TILLIS
Title or Position: HCA OFFICE MANAGER
Credential:
Phone: 352-401-1414