1285740720 NPI number — COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA PA

Table of content: (NPI 1285740720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285740720 NPI number — COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRADENTON ORTHOPAEDIC ASSOCIATES
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285740720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33622-0047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-792-1404
Provider Business Mailing Address Fax Number:
941-761-0712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 SR 64 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-792-1404
Provider Business Practice Location Address Fax Number:
941-761-0712
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEMAY
Authorized Official First Name:
PAIGE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
941-792-1404

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00712 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 264533500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CF1532 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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