Healthcare Provider Details

I. General information

NPI: 1487765566
Provider Name (Legal Business Name): GULF COAST ORTHOPEDIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7315 HUDSON AVE
HUDSON FL
34667-1158
US

IV. Provider business mailing address

PO BOX 5515
HUDSON FL
34674-5515
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-9563
  • Fax: 727-869-6909
Mailing address:
  • Phone: 727-868-9563
  • Fax: 727-869-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA DAWN HANSHEW
Title or Position: BUSINESS MANAGER
Credential: CPC
Phone: 727-868-9563