Healthcare Provider Details

I. General information

NPI: 1972882314
Provider Name (Legal Business Name): ORANGE CITY ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 TOWN CENTER DR STE 100
ORANGE CITY FL
32763
US

IV. Provider business mailing address

4919 MEMORIAL HWY STE 200
TAMPA FL
33634-7500
US

V. Phone/Fax

Practice location:
  • Phone: 386-456-5247
  • Fax: 386-456-0122
Mailing address:
  • Phone: 239-610-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF PARKS
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 813-569-6500