Healthcare Provider Details

I. General information

NPI: 1710171863
Provider Name (Legal Business Name): HEARTLAND ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 S HIGHLANDS AVE
SEBRING FL
33870-5416
US

IV. Provider business mailing address

PO BOX 552389
TAMPA FL
33655-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-867-8898
  • Fax: 352-732-6282
Mailing address:
  • Phone: 352-867-8898
  • Fax: 352-732-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN ROS-CARRETERO
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 352-867-8898