Basic Information
| Provider Information | |||||||||
| NPI: | 1508886367 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONSULTANT ANESTHETIC SERVICES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 92 E MCNAB RD | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330609238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545450337 | ||||||||
| FaxNumber: | 9545453497 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 LEE BLVD | ||||||||
| Address2: | |||||||||
| City: | LEHIGH ACRES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339364835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393684770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARLESS | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9545450337 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | UNK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00805 | 01 | FL | BLUE CROSS | OTHER |