MEDICARE: EAST COAST HOSPITAL INPATIENT SPECIALISTS PLC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK4021	OTHER	FL	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	34130	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1821078866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COAST HOSPITAL INPATIENT SPECIALISTS PLC

Provider Business Mailing Address
First Line	:	PO BOX 953457
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32795-3457
Country	:	US
Telephone Number	:	407-936-0976
Fax Number	:	407-936-0977

Provider Business Practice Location Address
First Line	:	2500 W LAKE MARY BLVD
Second Line	:	SUITE 101
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3501
Country	:	US
Telephone Number	:	407-936-0976
Fax Number	:	407-936-0977

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HASIB IBNE RASA
Credential	:	M.D.
Telephone Number	:	407-936-0976

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	03/06/2012

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