Provider Demographics
NPI:1255686515
Name:MANATEE HEARING & SPEECH CENTER INC
Entity Type:Organization
Organization Name:MANATEE HEARING & SPEECH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:941-749-5222
Mailing Address - Street 1:701 MANATEE AVE W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8604
Mailing Address - Country:US
Mailing Address - Phone:941-749-5222
Mailing Address - Fax:941-749-1839
Practice Address - Street 1:8648 E STATE ROAD 70
Practice Address - Street 2:RANCH LAKE PLAZA
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3785
Practice Address - Country:US
Practice Address - Phone:941-749-5222
Practice Address - Fax:941-749-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8207561OtherAETNA
FL8207561OtherAETNA