Provider Demographics
NPI:1700891637
Name:THOMAS M SWEENEY II M D PH D P A
Entity Type:Organization
Organization Name:THOMAS M SWEENEY II M D PH D P A
Other - Org Name:SOUTHEASTERN SPINE CENTER & RESEARCH INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MEDRICK
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:941-371-9773
Mailing Address - Street 1:5922 CATTLEMEN LN STE 201
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6204
Mailing Address - Country:US
Mailing Address - Phone:941-371-9773
Mailing Address - Fax:941-556-0341
Practice Address - Street 1:5922 CATTLEMEN LN STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6204
Practice Address - Country:US
Practice Address - Phone:941-371-9773
Practice Address - Fax:941-556-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45493OtherBLUE SHIELD ID NUMBER
FLDB1611OtherRAIL ROAD MEDICARE
FLDB1611OtherRAIL ROAD MEDICARE
FL45493OtherBLUE SHIELD ID NUMBER