Provider Demographics
NPI:1760548499
Name:ISLAND COAST ORTHOPEDICS, INC.
Entity Type:Organization
Organization Name:ISLAND COAST ORTHOPEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-573-9003
Mailing Address - Street 1:923 DEL PRADO, #204
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2075
Mailing Address - Country:US
Mailing Address - Phone:239-573-9003
Mailing Address - Fax:
Practice Address - Street 1:923 DEL PRADO BLVD S
Practice Address - Street 2:#204
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3652
Practice Address - Country:US
Practice Address - Phone:239-573-9003
Practice Address - Fax:239-573-7722
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISLAND COAST ORTHOPEDICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-28
Last Update Date:2016-06-06
Deactivation Date:2016-02-04
Deactivation Code:
Reactivation Date:2016-04-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1106790001Medicare NSC