Healthcare Provider Details

I. General information

NPI: 1497915524
Provider Name (Legal Business Name): TREASURE COAST HOSPITALIST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 NW FEDERAL HWY SUITE 151
STUART FL
34994-1000
US

IV. Provider business mailing address

3756 SW BIMINI CIR S
PALM CITY FL
34990-1335
US

V. Phone/Fax

Practice location:
  • Phone: 772-403-5860
  • Fax: 772-781-2680
Mailing address:
  • Phone: 772-403-5860
  • Fax: 772-781-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0050565
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME98874
License Number StateFL

VIII. Authorized Official

Name: MARY WOROBEY
Title or Position: BILLING MANAGER
Credential:
Phone: 772-403-5860