MEDICARE: GULFCOAST SURGERY CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	1147	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	490005687	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	286412	OTHER	FL	AVMED
2	6A4	OTHER	FL	BLUECROSS BLUESHIELD FLOR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5657489001	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1053314112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULFCOAST SURGERY CENTER PA

Provider Business Mailing Address
First Line	:	4947 CLARK RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-3252
Country	:	US
Telephone Number	:	941-924-9282
Fax Number	:	941-927-0797

Provider Business Practice Location Address
First Line	:	4947 CLARK RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-3252
Country	:	US
Telephone Number	:	941-924-9282
Fax Number	:	941-927-0797

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PHILIP H ASKINS
Credential	:
Telephone Number	:	941-924-9282

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/23/2013

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Directions to “GULFCOAST SURGERY CENTER PA ” Practice Location

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