Provider Demographics
NPI:1871633040
Name:COMMUNITY PHYSICIANS OF NORTH PORT PA
Entity Type:Organization
Organization Name:COMMUNITY PHYSICIANS OF NORTH PORT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHIDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-423-5053
Mailing Address - Street 1:14400 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2703
Mailing Address - Country:US
Mailing Address - Phone:941-423-5056
Mailing Address - Fax:941-423-5068
Practice Address - Street 1:14400 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2703
Practice Address - Country:US
Practice Address - Phone:941-423-5056
Practice Address - Fax:941-423-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7878207Q00000X
FLME 0066832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D0969781OtherCLIA
FL0001242368OtherHUMANA
FL77227OtherBCBS OF FLORIDA
338914OtherAETNA
FLDE0739OtherPALMETTO/RAILROAD MEDICARE
FL20773OtherCOLA