Provider Demographics
NPI:1417069170
Name:WEST COAST MEDICAL CRYSTAL RIVER, PA
Entity Type:Organization
Organization Name:WEST COAST MEDICAL CRYSTAL RIVER, PA
Other - Org Name:WEST COAST MEDICAL CRYSTAL RIVER PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-666-1703
Mailing Address - Street 1:PO BOX 5288
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-5288
Mailing Address - Country:US
Mailing Address - Phone:352-666-1703
Mailing Address - Fax:352-666-1366
Practice Address - Street 1:4131 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-2469
Practice Address - Country:US
Practice Address - Phone:352-666-1703
Practice Address - Fax:352-666-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270824800Medicaid
FL270824800Medicaid
FLDJ345AMedicare UPIN