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General NPI Number Information
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NPI Number | 1356689731
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Entity Type | Organization
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Legal Business Name | EAST COAST SURGICAL SPECIALTIES
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Dates
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Enumeration Date | 01/20/2013
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 787 37TH ST SUITE E170
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City | VERO BEACH
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State | FL
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Zip | 32960-7305
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Country | US
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Telephone | 561-244-9529
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Fax | 561-244-1929
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Provider Business Mailing Address
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Address Line | 787 37TH ST SUITE E170
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City | VERO BEACH
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State | FL
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Zip | 32960-7305
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Country | US
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Telephone | 561-244-9529
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Fax | 561-244-1929
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TY SCRIVENS
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Credential | SFA
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Telephone | 561-244-9529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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