MEDICARE: GULFSTREAM ANESTHESIA ASSOCIATES INC

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

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	:	1851569800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULFSTREAM ANESTHESIA ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1811 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4756
Country	:	US
Telephone Number	:	772-467-1960
Fax Number	:	772-467-1970

Provider Business Practice Location Address
First Line	:	1811 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4756
Country	:	US
Telephone Number	:	772-467-1960
Fax Number	:	772-467-1970

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH J KATTA
Credential	:	M.D.
Telephone Number	:	772-467-1960

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	03/25/2009

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