Organization
BEACHSIDE ANESTHESIA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MARGARET BOGER CRNA (PRESIDENT)
(321) 783-8926
Entity
Organization
Contact information
Practice address
95 BULLDOG BLVD, MELBOURNE, FL 32901-3332
(321) 729-9493
Mailing address
PO BOX 320281, COCOA BEACH, FL 32932-0281
(573) 686-5550
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ARNP9164912
STATE DEPT HEALTH
FL
Enumeration date
01/02/2018
Last updated
01/02/2018
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