Provider Demographics
NPI:1780349050
Name:RESTORE MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:RESTORE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-375-3006
Mailing Address - Street 1:333 TAMIAMI TRL S STE 101
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2425
Mailing Address - Country:US
Mailing Address - Phone:941-375-3006
Mailing Address - Fax:941-218-4825
Practice Address - Street 1:333 TAMIAMI TRL S STE 101
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2425
Practice Address - Country:US
Practice Address - Phone:941-375-3006
Practice Address - Fax:941-218-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center