1487800025 NPI number — MANASOTA MEDICAL GROUP LLC

Table of content: (NPI 1487800025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487800025 NPI number — MANASOTA MEDICAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANASOTA MEDICAL GROUP 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:
1487800025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 S TAMIAMI TRL
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34239-2221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-365-7771
Provider Business Mailing Address Fax Number:
941-365-4071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 S TAMIAMI TRL
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34239-2221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-365-7771
Provider Business Practice Location Address Fax Number:
941-365-4071
Provider Enumeration Date:
08/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE, MD
Authorized Official First Name:
BART
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
941-365-7771

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com