Provider Demographics
NPI:1124035746
Name:WESTCOAST BRACE & LIMB
Entity Type:Organization
Organization Name:WESTCOAST BRACE & LIMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-985-5000
Mailing Address - Street 1:5311 E FLETCHER AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617
Mailing Address - Country:US
Mailing Address - Phone:813-985-5000
Mailing Address - Fax:813-985-4499
Practice Address - Street 1:3285 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3424
Practice Address - Country:US
Practice Address - Phone:727-785-0100
Practice Address - Fax:727-785-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000250300Medicaid
FL0179970001Medicare NSC