Provider Demographics
NPI:1487606075
Name:MARTIN COUNTY ANESTHESIA GROUP PL
Entity type:Organization
Organization Name:MARTIN COUNTY ANESTHESIA GROUP PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-287-5200
Mailing Address - Street 1:75 REMITTANCE DR
Mailing Address - Street 2:SUITE 6634
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6634
Mailing Address - Country:US
Mailing Address - Phone:877-538-4594
Mailing Address - Fax:866-665-2702
Practice Address - Street 1:200 SE HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2346
Practice Address - Country:US
Practice Address - Phone:772-287-5200
Practice Address - Fax:866-665-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0888797OtherCIGNA GROUP NUMBER
FL252978500Medicaid
FLCH9103OtherRR MEDICARE GROUP#
FL77336OtherBCBS OF FL GR NUMBER
FL0888797OtherCIGNA GROUP NUMBER