Healthcare Provider Details

I. General information

NPI: 1326040908
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF CLAY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 KINGSLEY AVE SUITE 105
ORANGE PARK FL
32073-4490
US

IV. Provider business mailing address

PO BOX 850001 DEPT 121
ORLANDO FL
32885-0001
US

V. Phone/Fax

Practice location:
  • Phone: 904-215-7015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDY PAYNE
Title or Position: CREDENTIALING
Credential:
Phone: 904-421-2119