Provider Demographics
NPI:1356689731
Name:EAST COAST SURGICAL SPECIALTIES
Entity Type:Organization
Organization Name:EAST COAST SURGICAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:SFA
Authorized Official - Phone:561-244-9529
Mailing Address - Street 1:787 37TH ST
Mailing Address - Street 2:SUITE E170
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7305
Mailing Address - Country:US
Mailing Address - Phone:561-244-9529
Mailing Address - Fax:561-244-1929
Practice Address - Street 1:787 37TH ST
Practice Address - Street 2:SUITE E170
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7305
Practice Address - Country:US
Practice Address - Phone:561-244-9529
Practice Address - Fax:561-244-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-20
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty