Basic Information
| Provider Information | |||||||||
| NPI: | 1063828721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COAST TO COAST WOUND CARE SURGEONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 941 MCLEAN AVE | ||||||||
| Address2: | SUITE 387 | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107044107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142376797 | ||||||||
| FaxNumber: | 9142376790 | ||||||||
| Practice Location | |||||||||
| Address1: | 4411 N HABANA AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336147211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138722771 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2014 | ||||||||
| LastUpdateDate: | 02/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | BUNKER | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9142376797 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.