MEDICARE: WEST COAST - SOUTHERN MEDICAL SERVICE 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	3416L0300X	Land Ambulance	002614	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	590009510	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	080288100	OTHER	BLACK LUNG PROGRAM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	429840000	OTHER	MAINE CARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	00559	OTHER	UNIVERSAL HEALTHCARE
9	203246400	OTHER	US DEPT OF LABOR WORK COM
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740284785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COAST - SOUTHERN MEDICAL SERVICE INC

Provider Business Mailing Address
First Line	:	934 14TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-6646
Country	:	US
Telephone Number	:	941-748-7148
Fax Number	:	941-748-7265

Provider Business Practice Location Address
First Line	:	934 14TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-6646
Country	:	US
Telephone Number	:	941-748-7148
Fax Number	:	941-748-8520

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. CAROLE A. MCGOWAN
Credential	:	EMT-P
Telephone Number	:	941-748-7148

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	11/28/2012

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Directions to “WEST COAST - SOUTHERN MEDICAL SERVICE INC ” Practice Location

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