Provider Demographics
NPI:1366980641
Name:WEST COAST MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:WEST COAST MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-845-1933
Mailing Address - Street 1:5824 STATE ROAD 54
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-6002
Mailing Address - Country:US
Mailing Address - Phone:727-845-1933
Mailing Address - Fax:727-845-7307
Practice Address - Street 1:5824 STATE ROAD 54
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-6002
Practice Address - Country:US
Practice Address - Phone:727-845-1933
Practice Address - Fax:727-845-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3213962363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3213962OtherSTATE OF FLORIDA LICENSE NUMBHER