Provider Demographics
NPI:1902125958
Name:BAY AREA ANESTHESIA SPECIALISTS, LLC
Entity Type:Organization
Organization Name:BAY AREA ANESTHESIA SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:877-479-0450
Mailing Address - Street 1:PO BOX 850001 DEPT 0849
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0849
Mailing Address - Country:US
Mailing Address - Phone:877-479-0450
Mailing Address - Fax:866-665-2702
Practice Address - Street 1:6043 WINTHROP COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4272
Practice Address - Country:US
Practice Address - Phone:877-479-0450
Practice Address - Fax:866-665-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty