MEDICARE: TREASURE COAST HOSPITALIST PL

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	207R00000X	Internal Medicine Physician

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
2	98333	OTHER	FL	BLUE CROSS FLORIDA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457508236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREASURE COAST HOSPITALIST PL

Provider Business Mailing Address
First Line	:	PO BOX 1457
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34991-6457
Country	:	US
Telephone Number	:	772-249-5256
Fax Number	:	772-249-5274

Provider Business Practice Location Address
First Line	:	6692 SW SILVER WOLF DR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-8875
Country	:	US
Telephone Number	:	772-249-5256
Fax Number	:	772-249-5274

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARY S WOROBEY
Credential	:
Telephone Number	:	772-249-5256

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	12/21/2017

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