Organization
ANESTHESIOLOGY AND PAIN MANAGEMENT CONSULTANTS,LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH FOURNET MD (PRESIDENT)
(317) 614-9863
Entity
Organization
Contact information
Practice address
1324 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4543
(317) 614-9863
(844) 876-0873
Mailing address
PO BOX 106002, ATLANTA, GA 30348-6002
(317) 614-9863
(844) 876-0873
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
FL
367500000X
Certified Registered Nurse Anesthetist
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24871
BLUE CROSS BLUE SHILED
FL
05
—
376394300
—
FL
01
—
C11885
RAILROAD MEDICARE
FL
Enumeration date
06/18/2006
Last updated
08/26/2019
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