Provider Demographics
NPI:1134299753
Name:ASSOCIATED COASTAL EAR NOSE & THROAT PHYSICIANS PA
Entity Type:Organization
Organization Name:ASSOCIATED COASTAL EAR NOSE & THROAT PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-464-9595
Mailing Address - Street 1:4632 S 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981
Mailing Address - Country:US
Mailing Address - Phone:772-464-9595
Mailing Address - Fax:772-464-9582
Practice Address - Street 1:4632 S. 25TH STREET
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981
Practice Address - Country:US
Practice Address - Phone:954-587-4218
Practice Address - Fax:954-587-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34174OtherBCBSFL GRP#
FL261395600Medicaid
FL34174OtherBCBSFL GRP#
FL34174OtherBCBSFL GRP#