Provider Demographics
NPI:1538550975
Name:BAY AREA CONSORTIUM OF ANESTHESIA SERVICES OF FLORIDA, LLC
Entity type:Organization
Organization Name:BAY AREA CONSORTIUM OF ANESTHESIA SERVICES OF FLORIDA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-502-1155
Mailing Address - Street 1:1302 WAUGH DR
Mailing Address - Street 2:PMB 533
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-3908
Mailing Address - Country:US
Mailing Address - Phone:844-342-2227
Mailing Address - Fax:713-401-9758
Practice Address - Street 1:3111 45TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1974
Practice Address - Country:US
Practice Address - Phone:844-342-2227
Practice Address - Fax:713-401-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111629207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF16286Medicare UPIN