Healthcare Provider Details

I. General information

NPI: 1992713242
Provider Name (Legal Business Name): GULFSTREAM ANESTHESIA CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 GUTHRIE DR
TROY PA
16947-8115
US

IV. Provider business mailing address

PO BOX 212110
ROYAL PALM BEACH FL
33421-2110
US

V. Phone/Fax

Practice location:
  • Phone: 877-204-4155
  • Fax: 877-213-5232
Mailing address:
  • Phone: 877-204-4155
  • Fax: 877-213-5232

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: LAWRENCE M REID
Title or Position: PRESIDENT
Credential: MD
Phone: 561-204-5230