Provider Demographics
NPI:1295860302
Name:GOLD COAST SURGERY CENTER LLC
Entity Type:Organization
Organization Name:GOLD COAST SURGERY CENTER LLC
Other - Org Name:GULF COMPREHENSIVE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DITOMASO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-681-3555
Mailing Address - Street 1:1750 ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-1821
Mailing Address - Country:US
Mailing Address - Phone:941-681-3555
Mailing Address - Fax:941-681-3574
Practice Address - Street 1:1750 ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-1821
Practice Address - Country:US
Practice Address - Phone:941-681-3555
Practice Address - Fax:941-681-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1504Medicare PIN