Basic Information
| Provider Information | |||||||||
| NPI: | 1346212669 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL CITY ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 919030 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328919030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506564277 | ||||||||
| FaxNumber: | 8506564276 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 FLEISCHMANN RD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505520608 | ||||||||
| FaxNumber: | 8505520925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BIDWELL | ||||||||
| AuthorizedOfficialFirstName: | PATRICE | ||||||||
| AuthorizedOfficialMiddleName: | TALLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8506564277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 367500000X | FL | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.