Provider Demographics
NPI:1821324211
Name:MUA OF CHARLOTTE COUNTY LLC
Entity Type:Organization
Organization Name:MUA OF CHARLOTTE COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN NOSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-625-9800
Mailing Address - Street 1:PO BOX 864602
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 EDUCATION WAY
Practice Address - Street 2:
Practice Address - City:PT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1000
Practice Address - Country:US
Practice Address - Phone:941-625-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty