Healthcare Provider Details

I. General information

NPI: 1942498548
Provider Name (Legal Business Name): TREASURE COAST HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 SE CENTRAL PKWY
STUART FL
34994-3970
US

IV. Provider business mailing address

622 SE CENTRAL PKWY
STUART FL
34994-3970
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-1220
  • Fax: 772-288-5151
Mailing address:
  • Phone: 772-288-1220
  • Fax: 772-288-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS6350
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID A ELLIOTT
Title or Position: OWNER
Credential: D.O.
Phone: 772-288-1220