Basic Information
| Provider Information | |||||||||
| NPI: | 1043253826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VENICE CARDIOVASCULAR ANESTHESIA ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 SE 17TH ST STE 503 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344715176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524332825 | ||||||||
| FaxNumber: | 3524332893 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 THE RIALTO | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342852900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524332825 | ||||||||
| FaxNumber: | 3524332893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | PALMIRE | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3524332825 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 268014900 | 05 | FL | MEDICAID | 34679 | 01 | FL | BCBS OF FLORIDA | OTHER |