Provider Demographics
NPI:1811134794
Name:COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FL, PA
Entity type:Organization
Organization Name:COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-792-1404
Mailing Address - Street 1:8000 SR 64 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209
Mailing Address - Country:US
Mailing Address - Phone:941-792-1404
Mailing Address - Fax:941-761-0712
Practice Address - Street 1:6202 17TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7838
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2025-02-13
Deactivation Date:2018-07-27
Deactivation Code:
Reactivation Date:2018-10-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264533500Medicaid
FL0423780002Medicare NSC
FL0423780001Medicare NSC
FL264533500Medicaid
FL00712Medicare PIN