Provider Demographics
NPI:1114168457
Name:GOLD COAST PHYSICIANS CENTER INC
Entity Type:Organization
Organization Name:GOLD COAST PHYSICIANS CENTER INC
Other - Org Name:SOUTH FLA SPINE AND JOINT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-380-0477
Mailing Address - Street 1:1501 PRESIDENTIAL WAY
Mailing Address - Street 2:SUITE 19
Mailing Address - City:WEST PALM BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1800
Mailing Address - Country:US
Mailing Address - Phone:561-686-3201
Mailing Address - Fax:561-686-1622
Practice Address - Street 1:601 N CONGRESS AVE
Practice Address - Street 2:SUITE # 410
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4703
Practice Address - Country:US
Practice Address - Phone:561-686-3201
Practice Address - Fax:651-686-1622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty