1063443794 NPI number — TREASURE COAST MEDICAL SERVICES, INC.

Table of content: KATHY GAIL GIFFORD LPN (NPI 1841330370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063443794 NPI number — TREASURE COAST MEDICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TREASURE COAST MEDICAL SERVICES, INC.
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:
CLERMONT CARDIAC CENTER
Provider Other Organization Name Type Code:
3
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:
1063443794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3755 7TH TER
Provider Second Line Business Mailing Address:
SUITE 102, 203
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32960-6528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-770-2464
Provider Business Mailing Address Fax Number:
772-770-6323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 E. STATE ROAD 50
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-243-3517
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
772-770-2464

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  HCC4625 , 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)





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