Provider Demographics
NPI:1558584565
Name:SARASOTA FAMILY MEDICAL INC
Entity Type:Organization
Organization Name:SARASOTA FAMILY MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-923-5861
Mailing Address - Street 1:6813 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5603
Mailing Address - Country:US
Mailing Address - Phone:941-923-5861
Mailing Address - Fax:941-926-4547
Practice Address - Street 1:6813 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5603
Practice Address - Country:US
Practice Address - Phone:941-923-5861
Practice Address - Fax:941-926-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079271207Q00000X
FLME57727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE43811Medicare UPIN
FLDN1855Medicare PIN
FL5928450001Medicare NSC
FLP00608227Medicare PIN
FLCB1872Medicare PIN
FLP00609880Medicare PIN
FLE54241Medicare UPIN
FLBW8643632Medicare UPIN
FL5928450001Medicare PIN
FLAH300Medicare PIN