Provider Demographics
NPI:1124188685
Name:BRADENTON INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:BRADENTON INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROMINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-748-3065
Mailing Address - Street 1:701 MANATEE AVE W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8604
Mailing Address - Country:US
Mailing Address - Phone:941-748-3065
Mailing Address - Fax:941-748-8485
Practice Address - Street 1:701 MANATEE AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8604
Practice Address - Country:US
Practice Address - Phone:941-748-3065
Practice Address - Fax:941-748-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41570174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty