Organization
GULF COAST ORTHOPEDIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA DAWN HANSHEW CPC (BUSINESS MANAGER)
(727) 868-9563
Entity
Organization
Contact information
Practice address
7315 HUDSON AVE, HUDSON, FL 34667-1158
(727) 868-9563
(727) 869-6909
Mailing address
PO BOX 5515, HUDSON, FL 34674-5515
(727) 868-9563
(727) 869-6909
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
228711800
DEPARTMENT OF LABOR
FL
01
—
72078
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/31/2006
Last updated
01/26/2017
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