Basic Information
| Provider Information | |||||||||
| NPI: | 1548331192 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TBEC ANESTHESIA SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4809 N ARMENIA AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336031447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138729310 | ||||||||
| FaxNumber: | 8138729311 | ||||||||
| Practice Location | |||||||||
| Address1: | 4809 N ARMENIA AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336031447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138729310 | ||||||||
| FaxNumber: | 8138729311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 04/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | HEIMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8138729310 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | L05000023720 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00232021 | 01 | FL | RAILROAD MEDICARE | OTHER |