Healthcare Provider Details

I. General information

NPI: 1346212669
Provider Name (Legal Business Name): CAPITAL CITY ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 FLEISCHMANN RD
TALLAHASSEE FL
32308-4599
US

IV. Provider business mailing address

P.O. BOX 919030
ORLANDO FL
32891-9030
US

V. Phone/Fax

Practice location:
  • Phone: 850-552-0608
  • Fax: 850-552-0925
Mailing address:
  • Phone: 850-656-4277
  • Fax: 850-656-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. PATRICE TALLEY BIDWELL
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 850-656-4277