Basic Information
| Provider Information | |||||||||
| NPI: | 1194719575 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCALA REGIONAL MEDICAL CENTER ANESTHESIA INC | ||||||||
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| OtherOrganizationName: | OCALA REGIONAL MEDICAL CENTER ANESTHESIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1626 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344781626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528730516 | ||||||||
| FaxNumber: | 3528739726 | ||||||||
| Practice Location | |||||||||
| Address1: | 1431 SW 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344744000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524011000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROBERTS | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3528730516 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | CJ5538 | 01 | FL | RR MEDICARE GROUP NUMBER | OTHER |