Provider Demographics
NPI:1457344210
Name:THOMAS F BENDOWSKI MD PA
Entity Type:Organization
Organization Name:THOMAS F BENDOWSKI MD PA
Other - Org Name:GULF TO LAKE ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:BENDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-795-4422
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-0637
Mailing Address - Country:US
Mailing Address - Phone:352-795-4422
Mailing Address - Fax:352-795-1572
Practice Address - Street 1:6480 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7622
Practice Address - Country:US
Practice Address - Phone:352-795-4422
Practice Address - Fax:352-795-1572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063038207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
18225Medicare PIN
F44624Medicare UPIN