Healthcare Provider Details

I. General information

NPI: 1205109063
Provider Name (Legal Business Name): ATLANTIC ISLES INPATIENT SERVICES,LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SE TIFFANY AVE
PORT ST LUCIE FL
34952-7521
US

IV. Provider business mailing address

13737 NOEL ROAD 1600
DALLAS TX
75240
US

V. Phone/Fax

Practice location:
  • Phone: 973-251-1132
  • Fax:
Mailing address:
  • Phone: 973-251-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUG SMITH
Title or Position: OFFICER
Credential: MD
Phone: 973-251-1132