Provider Demographics
NPI:1598842692
Name:FLORIDA EAR & BALANCE CENTER PA
Entity Type:Organization
Organization Name:FLORIDA EAR & BALANCE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SUTLIVE
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:321-939-3000
Mailing Address - Street 1:PO BOX 470023
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-0023
Mailing Address - Country:US
Mailing Address - Phone:321-939-3000
Mailing Address - Fax:321-939-3001
Practice Address - Street 1:410 CELEBRATION PL STE 100
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5432
Practice Address - Country:US
Practice Address - Phone:321-939-3000
Practice Address - Fax:321-939-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38666174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94775OtherMEDICARE GROUP NUMBER