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NPI Code Detail

MEDICARE: FORT WALTON BEACH ANESTHESIA LLC

MEDICARE: FORT WALTON BEACH 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
1207L00000XAnesthesiology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CK6290OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
224572OTHERFLBLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538159652
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORT WALTON BEACH ANESTHESIA LLC
Provider Business Mailing Address
First Line : 8201 UNIVERSITY PKWY
Second Line :
City : PENSACOLA
State : FL
Zip : 32514-4904
Country : US
Telephone Number : 850-474-8688
Fax Number : 850-969-2910
Provider Business Practice Location Address
First Line : 1000 MAR WALT DR
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-6708
Country : US
Telephone Number : 850-474-8688
Fax Number : 850-969-2910
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : ANDY POPPLE
Credential :
Telephone Number : 850-474-8000
Provider Enumeration Date : 10/28/2005
Last Update Date : 06/24/2008

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Directions to “FORT WALTON BEACH ANESTHESIA LLC ” Practice Location

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