Provider Demographics
NPI:1942498548
Name:TREASURE COAST HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:TREASURE COAST HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-288-1220
Mailing Address - Street 1:622 SE CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3970
Mailing Address - Country:US
Mailing Address - Phone:772-288-1220
Mailing Address - Fax:772-288-5151
Practice Address - Street 1:622 SE CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3970
Practice Address - Country:US
Practice Address - Phone:772-288-1220
Practice Address - Fax:772-288-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6350207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373111100Medicaid
FL1811986581OtherDR. DAVID ELLIOTT'S NPI #
FL1811986581OtherDR. DAVID ELLIOTT'S NPI #
FL373111100Medicaid