Provider Demographics
NPI:1649319583
Name:ANESTHESIOLOGY OF MIAMI INC
Entity type:Organization
Organization Name:ANESTHESIOLOGY OF MIAMI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-542-0996
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-0029
Mailing Address - Country:US
Mailing Address - Phone:918-787-8980
Mailing Address - Fax:918-787-6052
Practice Address - Street 1:200 2ND AVE SW
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6830
Practice Address - Country:US
Practice Address - Phone:918-787-8980
Practice Address - Fax:918-787-6052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18831207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100096860AMedicaid
OK100096860AMedicaid