Basic Information
| Provider Information | |||||||||
| NPI: | 1225072069 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSCEOLA ANESTHESIA ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100806 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303840806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009012102 | ||||||||
| FaxNumber: | 4238925838 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 WEST OAK STREET | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347414996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078462266 | ||||||||
| FaxNumber: | 4075183616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 07/19/2011 | ||||||||
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| AuthorizedOfficialLastName: | NEGRIN | ||||||||
| AuthorizedOfficialFirstName: | MORRIS | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4234243829 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | CK5470 | 01 | FL | RAILROAD MEDICARE | OTHER | 265560800 | 05 | FL | MEDICAID | 34397 | 01 | FL | BCBSFL | OTHER |