Provider Demographics
NPI:1457654105
Name:ISLAND HEALTHCARE INC.
Entity Type:Organization
Organization Name:ISLAND HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:D'AMATO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-927-7009
Mailing Address - Street 1:4450 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3454
Mailing Address - Country:US
Mailing Address - Phone:941-927-7009
Mailing Address - Fax:941-929-9715
Practice Address - Street 1:4450 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3454
Practice Address - Country:US
Practice Address - Phone:941-927-7009
Practice Address - Fax:941-929-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
70392Medicare PIN