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NPI Code Detail

MEDICARE: ECSC III LLC

MEDICARE: ECSC III LLC
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
1207LP2900XPain Medicine (Anesthesiology) Physician
2367500000XCertified Registered Nurse Anesthetist
3207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1720242894
Entity Type Code : Organization
Provider Name (Legal Business Name) : ECSC III LLC
Provider Business Mailing Address
First Line : 201 MONTGOMERY AVE
Second Line :
City : SARASOTA
State : FL
Zip : 34243-1519
Country : US
Telephone Number : 941-360-1566
Fax Number : 941-358-9818
Provider Business Practice Location Address
First Line : 3535 LEE RD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44120-5122
Country : US
Telephone Number : 941-360-1566
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CARL R NOBACK
Credential : MD
Telephone Number : 941-360-1566
Provider Enumeration Date : 07/17/2008
Last Update Date : 07/17/2008

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