Healthcare Provider Details

I. General information

NPI: 1609109271
Provider Name (Legal Business Name): ADVANTAGE ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 DOCTORS DR
PANAMA CITY FL
32405-4454
US

IV. Provider business mailing address

PO BOX 850001 DEPT 0629
ORLANDO FL
32885-0629
US

V. Phone/Fax

Practice location:
  • Phone: 850-235-8948
  • Fax:
Mailing address:
  • Phone: 850-235-8948
  • 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 Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: OLIVER MARTIN HASEK JR.
Title or Position: MEMBER
Credential: MD
Phone: 850-235-8948