Provider Demographics
NPI:1285740720
Name:COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA PA
Entity type:Organization
Organization Name:COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-792-1404
Mailing Address - Street 1:8000 STATE ROAD 64 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-7703
Mailing Address - Country:US
Mailing Address - Phone:941-792-1404
Mailing Address - Fax:941-761-0712
Practice Address - Street 1:8000 SR 64 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:941-761-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00712OtherBCBS FL
FL264533500Medicaid
FLCF1532OtherRAILROAD MEDICARE
FL00712OtherBCBS FL
FL0423780005Medicare NSC
FL0423780004Medicare NSC
FL264533500Medicaid
FL0423780002Medicare NSC
FL00712Medicare PIN