Provider Demographics
NPI:1023685302
Name:PANHANDLE ANESTHESIA SERVICES
Entity type:Organization
Organization Name:PANHANDLE ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:RENFROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-477-8874
Mailing Address - Street 1:5330 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSALOCA
Mailing Address - State:FL
Mailing Address - Zip Code:35203
Mailing Address - Country:US
Mailing Address - Phone:850-447-8874
Mailing Address - Fax:850-477-8865
Practice Address - Street 1:5330 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSALOCA
Practice Address - State:FL
Practice Address - Zip Code:35203
Practice Address - Country:US
Practice Address - Phone:850-447-8874
Practice Address - Fax:850-477-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty