Provider Demographics
NPI:1316171010
Name:LAKE CITY OUTPATIENT ANESTHESIA
Entity type:Organization
Organization Name:LAKE CITY OUTPATIENT ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATION
Authorized Official - Prefix:
Authorized Official - First Name:RIZWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THANAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-487-3930
Mailing Address - Street 1:404 NW HALL OF FAME DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4833
Mailing Address - Country:US
Mailing Address - Phone:386-487-3930
Mailing Address - Fax:386-487-3935
Practice Address - Street 1:404 NW HALL OF FAME DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4833
Practice Address - Country:US
Practice Address - Phone:386-487-3930
Practice Address - Fax:386-487-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty