Provider Demographics
NPI:1982638730
Name:SUNCOAST ORTHOPAEDIC SURGERY & SPORTS MEDICINE, P.A.
Entity Type:Organization
Organization Name:SUNCOAST ORTHOPAEDIC SURGERY & SPORTS MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-485-1505
Mailing Address - Street 1:836 SUNSET LAKE BLVD
Mailing Address - Street 2:SUITE A 205
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-7556
Mailing Address - Country:US
Mailing Address - Phone:941-485-1505
Mailing Address - Fax:941-492-4065
Practice Address - Street 1:836 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE A 205
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7556
Practice Address - Country:US
Practice Address - Phone:941-485-1505
Practice Address - Fax:941-492-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1953Medicare ID - Type UnspecifiedGROUP NUMBER