Basic Information
| Provider Information | |||||||||
| NPI: | 1497199731 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TWIN CITIES ANESTHESIA ASSOCIATES, PL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7419 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328917419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666194860 | ||||||||
| FaxNumber: | 8666652702 | ||||||||
| Practice Location | |||||||||
| Address1: | 2190 HIGHWAY 85 N | ||||||||
| Address2: | |||||||||
| City: | NICEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325781045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506784131 | ||||||||
| FaxNumber: | 8507299342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2013 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | BROADERICK | ||||||||
| AuthorizedOfficialFirstName: | ARTHUR | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8508032297 | ||||||||
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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 | 207L00000X | ME69348 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.