Healthcare Provider Details

I. General information

NPI: 1316253438
Provider Name (Legal Business Name): TREASURE COAST UROLOGY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 37TH ST STE 4
VERO BEACH FL
32960-6550
US

IV. Provider business mailing address

1986 35TH AVE
VERO BEACH FL
32960-2533
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-9339
  • Fax: 772-562-5476
Mailing address:
  • Phone: 772-562-9339
  • Fax: 772-562-5476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH P CRAWFORD
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 772-562-9339