Organization
PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLIS B. NORSOPH M.D. (PRESIDENT)
(813) 899-6220
Entity
Organization
Contact information
Practice address
6101 PINE RIDGE RD, NAPLES, FL 34119-3900
(813) 899-6226
(813) 985-8006
Mailing address
PO BOX 26309, TAMPA, FL 33623-6309
(813) 899-6226
(813) 985-8006
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
4463
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4463
FLORIDA LICENSE
FL
Enumeration date
10/22/2010
Last updated
10/22/2010
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