Basic Information
| Provider Information | |||||||||
| NPI: | 1891789269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCALA SURGICAL CENTER ANESTHESIA INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OCALA SURGERY CENTER ANESTHESIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1626 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344781626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528736808 | ||||||||
| FaxNumber: | 3528739726 | ||||||||
| Practice Location | |||||||||
| Address1: | 3241 SW 34TH ST | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344747439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522375906 | ||||||||
| FaxNumber: | 3522378758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 02/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | HERRERA | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3528736808 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME86355 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 255540900 | 05 | FL | MEDICAID |