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General NPI Number Information
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NPI Number | 1932408705
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Entity Type | Organization
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Legal Business Name | CONCH REPUBLIC ANESTHESIA, LLC
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Dates
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Enumeration Date | 03/19/2011
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 931 TOPPINO DR
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City | KEY WEST
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State | FL
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Zip | 33040-4269
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Country | US
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Telephone | 305-453-6521
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 KEY PLZ # 289
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City | KEY WEST
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State | FL
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Zip | 33040-4077
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Country | US
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Telephone | 305-453-6521
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK J BRUSCIA
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Credential | D.O.
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Telephone | 305-453-6521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | OS 9660
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License Number State | FL
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