MEDICARE: ANESTHESIA ASSOCIATES OF CLAY COUNTY

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	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326040908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA ASSOCIATES OF CLAY COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 850001
Second Line	:	DEPT 121
City	:	ORLANDO
State	:	FL
Zip	:	32885-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1665 KINGSLEY AVE
Second Line	:	SUITE 105
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4490
Country	:	US
Telephone Number	:	904-215-7015
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	JUDY PAYNE
Credential	:
Telephone Number	:	904-421-2119

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/21/2016

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Directions to “ANESTHESIA ASSOCIATES OF CLAY COUNTY ” Practice Location

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