Basic Information
| Provider Information | |||||||||
| NPI: | 1215332523 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAY AREA PROFESSIONAL ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3683 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627083683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888514642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 W BAY DR | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337702207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275859500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2014 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | BIDANI | ||||||||
| AuthorizedOfficialFirstName: | JATIN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7274306897 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.