Provider Demographics
NPI:1588697551
Name:NATURE COAST ORTHOPAEDICS & SPORTS MEDICINE CLINIC, PA
Entity type:Organization
Organization Name:NATURE COAST ORTHOPAEDICS & SPORTS MEDICINE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-746-5707
Mailing Address - Street 1:PO BOX 640580
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-0580
Mailing Address - Country:US
Mailing Address - Phone:352-746-5707
Mailing Address - Fax:352-746-5944
Practice Address - Street 1:2155 W MUSTANG BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3520
Practice Address - Country:US
Practice Address - Phone:352-746-5707
Practice Address - Fax:352-746-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066779207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2586Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL1052730001Medicare NSC