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General NPI Number Information
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NPI Number | 1679847529
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Entity Type | Organization
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Legal Business Name | WEST COAST SURGICAL GROUP PLLC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 5953 17TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-7836
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Country | US
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Telephone | 941-746-8127
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Fax | 941-746-8127
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Provider Business Mailing Address
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Address Line | PO BOX 14731
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City | BRADENTON
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State | FL
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Zip | 34280-4731
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Country | US
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Telephone | 941-545-4002
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Fax | 941-748-6195
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Authorized Official
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Title or Position | MD
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Name | DR. PAIGE KOENIG PENNEBACKER
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Credential |
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Telephone | 941-761-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME62365
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License Number State | FL
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