Provider Demographics
NPI:1861560583
Name:BLUE ANGEL ANESTHESIA SERVICE
Entity type:Organization
Organization Name:BLUE ANGEL ANESTHESIA SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:COULAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-494-0048
Mailing Address - Street 1:4600 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2337
Mailing Address - Country:US
Mailing Address - Phone:850-494-0048
Mailing Address - Fax:850-494-0065
Practice Address - Street 1:4600 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2337
Practice Address - Country:US
Practice Address - Phone:850-494-0048
Practice Address - Fax:850-494-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34515OtherBCBS
FL34515Medicare ID - Type Unspecified