Provider Demographics
NPI:1992713242
Name:GULFSTREAM ANESTHESIA CONSULTANTS PA
Entity type:Organization
Organization Name:GULFSTREAM ANESTHESIA CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-204-5230
Mailing Address - Street 1:PO BOX 212110
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33421-2110
Mailing Address - Country:US
Mailing Address - Phone:877-204-4155
Mailing Address - Fax:877-213-5232
Practice Address - Street 1:275 GUTHRIE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-8115
Practice Address - Country:US
Practice Address - Phone:877-204-4155
Practice Address - Fax:877-213-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012390590002Medicaid
PA1012390590001Medicaid
PA1012390590001Medicaid