Provider Demographics
NPI:1124859459
Name:TREASURE COAST MEDORTHO LLC
Entity type:Organization
Organization Name:TREASURE COAST MEDORTHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATACHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-559-5117
Mailing Address - Street 1:2221 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4796
Mailing Address - Country:US
Mailing Address - Phone:772-577-7020
Mailing Address - Fax:772-577-7021
Practice Address - Street 1:2221 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4796
Practice Address - Country:US
Practice Address - Phone:772-577-7020
Practice Address - Fax:772-577-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty