Healthcare Provider Details

I. General information

NPI: 1457610537
Provider Name (Legal Business Name): WEST COAST EAR, NOSE & THROAT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S FORT HARRISON AVE
CLEARWATER FL
33756-3313
US

IV. Provider business mailing address

1330 S FORT HARRISON AVE
CLEARWATER FL
33756-3313
US

V. Phone/Fax

Practice location:
  • Phone: 727-216-0700
  • Fax: 727-216-0704
Mailing address:
  • Phone: 727-216-0700
  • Fax: 727-216-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME54343
License Number StateFL

VIII. Authorized Official

Name: MRS. TRACIE BABCOCK
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 727-216-0700