Provider Demographics
NPI:1063443794
Name:TREASURE COAST MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:TREASURE COAST MEDICAL SERVICES, INC.
Other - Org Name:CLERMONT CARDIAC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RT CNMT
Authorized Official - Phone:772-770-2464
Mailing Address - Street 1:3755 7TH TER
Mailing Address - Street 2:SUITE 102, 203
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6528
Mailing Address - Country:US
Mailing Address - Phone:772-770-2464
Mailing Address - Fax:772-770-6323
Practice Address - Street 1:1725 E. STATE ROAD 50
Practice Address - Street 2:SUITE A
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-243-3517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4625261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
E7835AMedicare ID - Type Unspecified