Provider Demographics
NPI:1568609444
Name:COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA PA
Entity Type:Organization
Organization Name:COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-792-1404
Mailing Address - Street 1:6015 POINTE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5532
Mailing Address - Country:US
Mailing Address - Phone:941-792-1404
Mailing Address - Fax:
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5180
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2024-02-12
Deactivation Date:2018-07-27
Deactivation Code:
Reactivation Date:2018-10-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264533500Medicaid
FL0423780002Medicare NSC
FL00712Medicare PIN
FL264533500Medicaid
FL0423780003Medicare NSC