# WEST FLORIDA TRAUMA NETWORK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902198948
- **Authorized official:** WILLIAM TEDRICK JOHNSON (GROUP VICE PRESIDENT/AO)
- **Authorized official phone:** (615) 372-3375

## Contact information

- **Practice address:** 2010 59TH ST W, SUITE 2200, BRADENTON, FL 34209-4616
- **Practice address phone:** (813) 453-0590
- **Mailing address:** 2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4525
- **Mailing address phone:** (615) 373-7600
- **Mailing address fax:** (866) 346-1426

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |
| 2086S0127X | Trauma Surgery Physician | — | NULL | Yes |
| 2086S0127X | Trauma Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/10/2011
- **Last updated:** 10/15/2020