Provider Demographics
NPI:1194193888
Name:SPACE COAST ANESTHESIOLOGY AND PAIN MEDICINE PLLC
Entity type:Organization
Organization Name:SPACE COAST ANESTHESIOLOGY AND PAIN MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-433-1166
Mailing Address - Street 1:907 PREAKNESS PL
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6112
Mailing Address - Country:US
Mailing Address - Phone:321-433-1166
Mailing Address - Fax:321-433-1166
Practice Address - Street 1:907 PREAKNESS PL
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6112
Practice Address - Country:US
Practice Address - Phone:321-433-1166
Practice Address - Fax:321-433-1166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPACE COAST ANESTHESIOLOGY AND PAIN MEDICINE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80599207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty