Healthcare Provider Details

I. General information

NPI: 1013293562
Provider Name (Legal Business Name): CENTER FOR MEN'S HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 INTERSTATE BLVD
SARASOTA FL
34240-8996
US

IV. Provider business mailing address

399 INTERSTATE BLVD
SARASOTA FL
34240-8996
US

V. Phone/Fax

Practice location:
  • Phone: 941-388-7163
  • Fax:
Mailing address:
  • Phone: 941-388-7163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberHCCE604622
License Number StateFL

VIII. Authorized Official

Name: MR. PAUL A SLOAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 941-349-6583