Provider Demographics
NPI:1528005063
Name:WEST COAST PODIATRY CENTER, INC.
Entity Type:Organization
Organization Name:WEST COAST PODIATRY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LASDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-753-9599
Mailing Address - Street 1:1611 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-2868
Mailing Address - Country:US
Mailing Address - Phone:941-753-9599
Mailing Address - Fax:941-755-0261
Practice Address - Street 1:1611 53RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2868
Practice Address - Country:US
Practice Address - Phone:941-753-9599
Practice Address - Fax:941-755-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390324900Medicaid
1003030001Medicare NSC
FL390324900Medicaid