Provider Demographics
NPI:1932198876
Name:BRADENTON SURGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:BRADENTON SURGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-748-1471
Mailing Address - Street 1:5601 21ST AVE W
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5642
Mailing Address - Country:US
Mailing Address - Phone:941-748-1471
Mailing Address - Fax:941-748-6195
Practice Address - Street 1:5601 21ST AVE W
Practice Address - Street 2:SUITE D
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5642
Practice Address - Country:US
Practice Address - Phone:941-748-1471
Practice Address - Fax:941-748-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00069Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #