Basic Information
| Provider Information | |||||||||
| NPI: | 1477212462 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA DYNAMICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | LB #8247 PO BOX 95000 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404692181 | ||||||||
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| Practice Location | |||||||||
| Address1: | 960 7TH AVE N | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337051347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404692181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2021 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | ADKINS | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING CONTACT | ||||||||
| AuthorizedOfficialTelephone: | 2404692181 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ANESTHESIA DYNAMICS LLC | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.