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NPI Code Detail

MEDICARE: BAYSHORE ANESTHESIA P A

MEDICARE: BAYSHORE ANESTHESIA P A
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
1207LP2900XPain Medicine (Anesthesiology) PhysicianME69348FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128253OTHERFLBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659477461
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAYSHORE ANESTHESIA P A
Provider Business Mailing Address
First Line : PO BOX 7419
Second Line :
City : ORLANDO
State : FL
Zip : 32891-7419
Country : US
Telephone Number : 352-867-8898
Fax Number : 352-732-6282
Provider Business Practice Location Address
First Line : 2190 HIGHWAY 85 N
Second Line :
City : NICEVILLE
State : FL
Zip : 32578-1045
Country : US
Telephone Number : 352-867-8898
Fax Number : 352-732-6282
Authorized Official
Title or Position : MD/PRESIDENT
Name : DR. ARTHUR PAUL BROADERICK
Credential : MD
Telephone Number : 352-867-8898
Provider Enumeration Date : 09/16/2006
Last Update Date : 08/09/2011

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Directions to “BAYSHORE ANESTHESIA P A ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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