=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265604904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOLCOTT CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2008
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1511 US HIGHWAY 1 STE 104
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-388-3344
-----------------------------------------------------
Fax | 772-388-4002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1511 US HIGHWAY 1 STE 104
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-388-3344
-----------------------------------------------------
Fax | 772-388-4002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAMES A WOLCOTT
-----------------------------------------------------
Credential | CRNA ARNP
-----------------------------------------------------
Telephone | 772-388-3344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | ARNP 9203833
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------