Healthcare Provider Details

I. General information

NPI: 1063085744
Provider Name (Legal Business Name): BAY AREA ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 TRINITY OAKS BLVD
TRINITY FL
34655-4402
US

IV. Provider business mailing address

PO BOX 743617
ATLANTA GA
30374-3617
US

V. Phone/Fax

Practice location:
  • Phone: 954-939-5000
  • Fax: 877-250-6889
Mailing address:
  • Phone: 954-939-5000
  • Fax: 877-250-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER KENNEDY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 207-807-9009