MEDICARE: SPBAS 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1558641225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPBAS LLC

Provider Business Mailing Address
First Line	:	5501 W GRAY ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1007
Country	:	US
Telephone Number	:	813-569-6500
Fax Number	:	813-864-4030

Provider Business Practice Location Address
First Line	:	28747 WOODWARD AVE
Second Line	:
City	:	BERKLEY
State	:	MI
Zip	:	48072-0929
Country	:	US
Telephone Number	:	246-584-4602
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF OPERATIONS
Name	:	JEFF D. PARKS
Credential	:
Telephone Number	:	813-569-6500

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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