Organization
SPACE COAST ANESTHESIA SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF PARKS (SENIOR VICE PRESIDENT)
(813) 569-6500
Entity
Organization
Contact information
Practice address
595 N COURTENAY PKWY, 103, MERRITT ISLAND, FL 32953
(813) 569-6500
(813) 569-6262
Mailing address
4919 MEMORIAL HWY STE 200, TAMPA, FL 33634-7500
(239) 610-0775
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
03/09/2009
Last updated
05/25/2021
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