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General NPI Number Information
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NPI Number | 1508826355
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Entity Type | Organization
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Legal Business Name | NATURE COAST PEDIATRICS, INC
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 512 N LECANTO HWY
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City | LECANTO
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State | FL
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Zip | 34461-8547
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Country | US
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Telephone | 352-527-2244
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Fax | 352-527-2204
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Provider Business Mailing Address
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Address Line | 512 N LECANTO HWY
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City | LECANTO
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State | FL
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Zip | 34461-8547
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Country | US
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Telephone | 352-527-2244
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Fax | 352-527-2204
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Authorized Official
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Title or Position | PRESIDENT
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Name | KOMALA N BHUSHAN
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Credential | M.D.
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Telephone | 352-527-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | ME68580
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License Number State | FL
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