=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477125912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANESTHESIA PHYSICIAN SOLUTIONS OF SOUTH FLORIDA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2021
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3641 S MIAMI AVE FL 4
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33133-4204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-939-5000
-----------------------------------------------------
Fax | 877-250-6889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 744522
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30374-4522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-939-5000
-----------------------------------------------------
Fax | 877-250-6889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | CHRISTOPHER KENNEDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-807-9009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------