Provider Demographics
NPI:1396866653
Name:INJURY TREATMENT CENTER OF CORAL SPRINGS INC
Entity Type:Organization
Organization Name:INJURY TREATMENT CENTER OF CORAL SPRINGS INC
Other - Org Name:CHOICE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING DEPT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-817-9402
Mailing Address - Street 1:2295 NW CORPORATE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7373
Mailing Address - Country:US
Mailing Address - Phone:561-241-1971
Mailing Address - Fax:561-241-3969
Practice Address - Street 1:871 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-1731
Practice Address - Country:US
Practice Address - Phone:954-567-5730
Practice Address - Fax:954-567-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3662208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34548OtherBLUE SHIELD NUMBER
FL34548OtherBLUE SHIELD NUMBER