Provider Demographics
NPI:1215939590
Name:MANATEE HEARING & SPEECH CENTER, INC.
Entity type:Organization
Organization Name:MANATEE HEARING & SPEECH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:941-749-5222
Mailing Address - Street 1:701 MANATEE AVE W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8604
Mailing Address - Country:US
Mailing Address - Phone:941-749-5222
Mailing Address - Fax:941-749-1839
Practice Address - Street 1:701 MANATEE AVE W
Practice Address - Street 2:SUITE 201
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8604
Practice Address - Country:US
Practice Address - Phone:941-749-5222
Practice Address - Fax:941-749-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037353207Y00000X
FLME0045512207Y00000X
FLME0059977207Y00000X
FLME0070294207Y00000X
FLME0062805207Y00000X
FLME0059281207Y00000X
FLME0085106207Y00000X
FLAY0000055231H00000X
FLAY0000166231H00000X
FLAY0000465231H00000X
FLAY0000828231H00000X
FLAY0000946231H00000X
FLSA0001059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17288Medicaid
FLJ0017OtherBCBS GROUP
FL8207561OtherAETNA
FLJ0017OtherBCBS GROUP
FL8207561OtherAETNA