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General NPI Number Information
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NPI Number | 1942441753
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Entity Type | Organization
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Legal Business Name | SPACE COAST ANESTHESIA SERVICES LLC
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 595 N COURTENAY PKWY 103
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City | MERRITT ISLAND
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State | FL
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Zip | 32953
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Country | US
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Telephone | 813-569-6500
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Fax | 813-569-6262
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Provider Business Mailing Address
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Address Line | 4919 MEMORIAL HWY STE 200
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City | TAMPA
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State | FL
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Zip | 33634-7500
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Country | US
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Telephone | 239-610-0775
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | JEFF PARKS
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Credential |
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Telephone | 813-569-6500
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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 |
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License Number State |
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