Basic Information
| Provider Information | |||||||||
| NPI: | 1124403191 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MID-FLORIDA ANESTHESIA ASSOCIATES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RESOLUTE PAIN SOLUTIONS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 W CAMINO REAL | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334335510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614652598 | ||||||||
| FaxNumber: | 5614652599 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 GLADES RD | ||||||||
| Address2: | SUITE 5-A | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723377676 | ||||||||
| FaxNumber: | 7723379034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2015 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5614652598 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RESOLUTE ANESTHESIA AND PAIN SOLUTIONS, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | FL | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.