Provider Demographics
NPI:1932557485
Name:ISLAND COAST O & P
Entity Type:Organization
Organization Name:ISLAND COAST O & P
Other - Org Name:ISLAND COAST ORTHOPEDICS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLENE RYDER
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-573-9003
Mailing Address - Street 1:2003 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-6314
Mailing Address - Country:US
Mailing Address - Phone:239-573-9003
Mailing Address - Fax:
Practice Address - Street 1:923 DEL PRADO BLVD S
Practice Address - Street 2:#204
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3652
Practice Address - Country:US
Practice Address - Phone:239-573-9003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT110335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier