MEDICARE: ST. LUCIE ANESTHESIA ASSOCIATES 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	:	1871267625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LUCIE ANESTHESIA ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 745923
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-5923
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:	877-250-6889

Provider Business Practice Location Address
First Line	:	555 SE 5TH AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5212
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:	877-250-6889

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	CHRISTOPHER KENNEDY
Credential	:
Telephone Number	:	207-807-9009

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	06/15/2026

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