1508857871 NPI number — MANATEE SURGICAL CENTER, LLC

Table of content: (NPI 1508857871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508857871 NPI number — MANATEE SURGICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANATEE SURGICAL CENTER, LLC
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:
Provider Other Organization Name Type Code:
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:
1508857871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 MANATEE AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34205-8610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-745-2727
Provider Business Mailing Address Fax Number:
941-745-2112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 MANATEE AVE W
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:
34205-8610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-745-2727
Provider Business Practice Location Address Fax Number:
941-745-2112
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WEINKLE
Authorized Official First Name:
DANA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
941-794-2020

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  1096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 170301000 . This is a "US DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 187360 . This is a "STAY WELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 68D . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 490004511 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2273604 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 076167200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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