MEDICARE: NATURE COAST NEUROSUGERY INC

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	174400000X	Specialist	ME94451	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063631133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURE COAST NEUROSUGERY INC

Provider Business Mailing Address
First Line	:	13911 LAKESHORE BLVD
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-7102
Country	:	US
Telephone Number	:	727-862-1234
Fax Number	:	727-862-1616

Provider Business Practice Location Address
First Line	:	13911 LAKESHORE BLVD
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-7102
Country	:	US
Telephone Number	:	727-862-1234
Fax Number	:	727-862-1616

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WAYNE L WITTENBERG
Credential	:	MD
Telephone Number	:	727-862-1234

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	01/23/2008

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Directions to “NATURE COAST NEUROSUGERY INC ” Practice Location

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