Basic Information
| Provider Information | |||||||||
| NPI: | 1649319583 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIOLOGY OF MIAMI INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743550029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187878980 | ||||||||
| FaxNumber: | 9187876052 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 2ND AVE SW | ||||||||
| Address2: | ANESTHESIA DEPARTMENT | ||||||||
| City: | MIAMI | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743546830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187878980 | ||||||||
| FaxNumber: | 9187876052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | OSBORN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 9185420996 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 18831 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 100096860A | 05 | OK | MEDICAID |