MEDICARE: ULTIMATE ANESTHESIOLOGY 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	:	1972521425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE ANESTHESIOLOGY LLC

Provider Business Mailing Address
First Line	:	PO BOX 152877
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33684-2877
Country	:	US
Telephone Number	:	813-873-2496
Fax Number	:	813-874-1524

Provider Business Practice Location Address
First Line	:	4178 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6429
Country	:	US
Telephone Number	:	813-873-2496
Fax Number	:	813-874-1524

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN ELIAS BARSA
Credential	:	MD
Telephone Number	:	813-873-2496

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	10/10/2012

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