Basic Information
| Provider Information | |||||||||
| NPI: | 1306279641 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TREASURE COAST MEDICAL CONCIERGE, LLC | ||||||||
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| OtherOrganizationName: | TREASURE COAST CONCIERGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2384B SE OCEAN BLVD | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349963310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722235630 | ||||||||
| FaxNumber: | 7722235691 | ||||||||
| Practice Location | |||||||||
| Address1: | 2384B SE OCEAN BLVD | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349963310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722235630 | ||||||||
| FaxNumber: | 7722235691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2013 | ||||||||
| LastUpdateDate: | 08/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | ROBBINS | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7723417720 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.