MEDICARE: NATURE COAST ORTHOPAEDICS & SPORTS MEDICINE CLINIC, 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	207X00000X	Orthopaedic Surgery Physician	ME0066779	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	:	1588697551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURE COAST ORTHOPAEDICS & SPORTS MEDICINE CLINIC, PA

Provider Business Mailing Address
First Line	:	PO BOX 640580
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34464-0580
Country	:	US
Telephone Number	:	352-746-5707
Fax Number	:	352-746-5944

Provider Business Practice Location Address
First Line	:	2155 W MUSTANG BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3520
Country	:	US
Telephone Number	:	352-746-5707
Fax Number	:	352-746-5944

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WALTER CHOUNG
Credential	:	MD
Telephone Number	:	352-746-5707

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	02/10/2009

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