Basic Information
| Provider Information | |||||||||
| NPI: | 1891730321 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIOLOGY AND PAIN MANAGEMENT CONSULTANTS,LC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 106002 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303486002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176149863 | ||||||||
| FaxNumber: | 8448760873 | ||||||||
| Practice Location | |||||||||
| Address1: | 1324 LAKELAND HILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338054543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176149863 | ||||||||
| FaxNumber: | 8448760873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | FOURNET | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3176149863 | ||||||||
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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 | 367500000X | FL | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207LP2900X | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 24871 | 01 | FL | BLUE CROSS BLUE SHILED | OTHER | 376394300 | 05 | FL | MEDICAID | C11885 | 01 | FL | RAILROAD MEDICARE | OTHER |