MEDICARE: NORTHEAST 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1720321904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 660257
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35266-0257
Country	:	US
Telephone Number	:	205-979-5882
Fax Number	:	205-979-1248

Provider Business Practice Location Address
First Line	:	2438 DR MARTIN LUTHER KING JR ST N STE C
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-2750
Country	:	US
Telephone Number	:	727-565-0740
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	RAMSES S NASHED
Credential	:	MD
Telephone Number	:	727-565-0740

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	08/08/2019

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