Provider Demographics
NPI:1497915524
Name:TREASURE COAST HOSPITALIST PA
Entity Type:Organization
Organization Name:TREASURE COAST HOSPITALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOROBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-403-5860
Mailing Address - Street 1:3756 SW BIMINI CIR S
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-1335
Mailing Address - Country:US
Mailing Address - Phone:772-403-5860
Mailing Address - Fax:772-781-2680
Practice Address - Street 1:850 NW FEDERAL HWY
Practice Address - Street 2:SUITE 151
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-1000
Practice Address - Country:US
Practice Address - Phone:772-403-5860
Practice Address - Fax:772-781-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050565207Q00000X
FLME98874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty