Provider Demographics
NPI:1275605131
Name:FLORIDAGULFCOAST EARNOSEANDTHROAT LLC
Entity Type:Organization
Organization Name:FLORIDAGULFCOAST EARNOSEANDTHROAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-514-2225
Mailing Address - Street 1:2180 IMMOKALEE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1422
Mailing Address - Country:US
Mailing Address - Phone:239-514-2225
Mailing Address - Fax:239-514-2280
Practice Address - Street 1:2180 IMMOKALEE RD STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1422
Practice Address - Country:US
Practice Address - Phone:239-514-2225
Practice Address - Fax:239-514-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94911OtherBLUE SHIELD PROVIDER NUMB
FL94911OtherBLUE SHIELD PROVIDER NUMB
FL94911Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER