Provider Demographics
NPI:1801831003
Name:LUNG ASSOCIATES OF SARASOTA LLC
Entity Type:Organization
Organization Name:LUNG ASSOCIATES OF SARASOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-366-5864
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:STE. 705
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2913
Mailing Address - Country:US
Mailing Address - Phone:941-366-5864
Mailing Address - Fax:941-365-4276
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:STE. 705
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2913
Practice Address - Country:US
Practice Address - Phone:941-366-5864
Practice Address - Fax:941-365-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041874207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39516Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER