MEDICARE: VISION ANESTHESIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1134740319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 4485
Second Line	:	DEPT 1200
City	:	HOUSTON
State	:	TX
Zip	:	77210-4485
Country	:	US
Telephone Number	:	941-360-1566
Fax Number	:	941-358-9818

Provider Business Practice Location Address
First Line	:	9726 TOUCHTON RD STE 305
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-8307
Country	:	US
Telephone Number	:	904-686-6020
Fax Number	:	904-619-8879

Authorized Official
Title or Position	:	MEMBER/MANAGER
Name	:	KIRBY KITCHENS
Credential	:	CRNA
Telephone Number	:	941-360-1566

Provider Enumeration Date	:	04/29/2020
Last Update Date	:	07/22/2021

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Directions to “VISION ANESTHESIA LLC ” Practice Location

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