| Entity Name: | CITRUS CARDIOVASCULAR ANESTHESIA ASSOCIATES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Aug 2002 (22 years ago) |
| Document Number: | L02000020017 |
| FEI/EIN Number | 061643831 |
| Address: | 150 SE 17th St., #503, OCALA, FL, 34471, US |
| Mail Address: | 150 SE 17th St., #503, OCALA, FL, 34471, US |
| ZIP code: | 34471 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508809385 | 2006-06-13 | 2020-08-25 | 150 SE 17TH ST STE 503, OCALA, FL, 344715176, US | 502 W HIGHLAND BLVD, INVERNESS, FL, 344524720, US | |||||||||||||||||||||||||||
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| Phone | +1 352-433-2825 |
| Fax | 3524332893 |
Authorized person
| Name | VINCENT C. PALMIRE |
| Role | PARTNER |
| Phone | 3524332825 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FLORIDA |
| Number | 34910 |
| State | FL |
| Issuer | MEDICAID |
| Number | 269237600 |
| State | FL |
| Name | Role |
|---|---|
| CHESTNUT BUSINESS SERVICES, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| PALMIRE VINCENT C | Manager | 150 SE 17th St., OCALA, FL, 34471 |
| DEPUTAT MIKHAIL M | Manager | 150 SE 17th St., OCALA, FL, 34471 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
