Provider Demographics
NPI:1619058336
Name:NATURE COAST SURGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:NATURE COAST SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MANUBAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-596-5919
Mailing Address - Street 1:11343 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5404
Mailing Address - Country:US
Mailing Address - Phone:352-596-5919
Mailing Address - Fax:352-596-5918
Practice Address - Street 1:11343 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5404
Practice Address - Country:US
Practice Address - Phone:352-596-5919
Practice Address - Fax:352-596-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X
FLME 757412086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00889OtherUNIVERSAL
FL217051OtherWELLCARE
FL241641OtherAVMED
FL255398800Medicaid
FL59020000449310OtherBC BS NATL ACCT
FL44931OtherBLUE CROSS BLUE SHIELD FL
FL3668439OtherAETNA
FL59020000449310OtherBC BS NATL ACCT
FL=========OtherTRICARE
FL217051OtherWELLCARE
FL255398800Medicaid