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NPI Code Detail

MEDICARE: MANATEE SPECIALTY PHYSICIAN ALLIANCE, LLC

MEDICARE: MANATEE SPECIALTY PHYSICIAN ALLIANCE, 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
12084N0400XNeurology Physician
2208600000XSurgery Physician
3207V00000XObstetrics & Gynecology Physician
4207VX0201XGynecologic Oncology Physician
5207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1881304624
Entity Type Code : Organization
Provider Name (Legal Business Name) : MANATEE SPECIALTY PHYSICIAN ALLIANCE, LLC
Provider Business Mailing Address
First Line : 367 S GULPH RD
Second Line :
City : KING OF PRUSSIA
State : PA
Zip : 19406-3121
Country : US
Telephone Number : 484-913-7527
Fax Number :
Provider Business Practice Location Address
First Line : 714 MANATEE AVE E
Second Line :
City : BRADENTON
State : FL
Zip : 34208-1235
Country : US
Telephone Number : 941-212-2010
Fax Number :
Authorized Official
Title or Position : VP - PHYS. OPERATIONS
Name : TODD EVANS
Credential :
Telephone Number : 610-382-4422
Provider Enumeration Date : 12/02/2022
Last Update Date : 10/30/2023

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1881924397 — JILL HOLLY ERBELLA PA
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