Provider Demographics
NPI:1477108066
Name:CONSULTING HIDDEN SPRINGS, LLC
Entity Type:Organization
Organization Name:CONSULTING HIDDEN SPRINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-916-3700
Mailing Address - Street 1:1040 GULF BREEZE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7808
Mailing Address - Country:US
Mailing Address - Phone:850-916-3700
Mailing Address - Fax:850-916-3710
Practice Address - Street 1:1040 GULF BREEZE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7808
Practice Address - Country:US
Practice Address - Phone:850-916-3700
Practice Address - Fax:850-916-3710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty