Provider Demographics
NPI:1306015359
Name:JAMES D SHORTT M D P A
Entity Type:Organization
Organization Name:JAMES D SHORTT M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CIRIECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-955-1231
Mailing Address - Street 1:PO BOX 25036
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2036
Mailing Address - Country:US
Mailing Address - Phone:941-955-1231
Mailing Address - Fax:941-378-3444
Practice Address - Street 1:5741 BEE RIDGE RD
Practice Address - Street 2:SUITE 590
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5064
Practice Address - Country:US
Practice Address - Phone:941-955-1231
Practice Address - Fax:941-378-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207X00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24154OtherBLUE CROSS BLUE SHIELD
FLAJO33Medicare PIN