| Gastroenterology Specialist Of The Treasure Coast, Inc | |
|
501 Nw Lake Whitney Pl Ste 102 Port St Lucie FL 34986-1615 | |
| (772) 359-0091 | |
| Not Available |
| Full Name | Gastroenterology Specialist Of The Treasure Coast, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 501 Nw Lake Whitney Pl Ste 102, Port St Lucie, Florida |
| Authorized Official Name and Position | Jayshree Matadial (PRESIDENT) |
| Authorized Official Contact | 7723590091 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastroenterology Specialist Of The Treasure Coast, Inc Po Box 8090 Port St Lucie FL 34985-8090 Ph: (772) 359-0091 | Gastroenterology Specialist Of The Treasure Coast, Inc 501 Nw Lake Whitney Pl Ste 102 Port St Lucie FL 34986-1615 Ph: (772) 359-0091 |
| NPI Number | 1477888444 |
|---|---|
| Provider Enumeration Date | 10/08/2009 |
| Last Update Date | 05/26/2020 |
| Medicare PECOS PAC ID | 6901948645 |
|---|---|
| Medicare Enrollment ID | O20100119000645 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477888444 | NPI | - | NPPES |
| ME77972 | Other | FL | MEDICAL LICENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | ME77972 (Florida) | Primary |
| Provider Name | Jayshree Matadial |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1568416030 PECOS PAC ID: 9638249949 Enrollment ID: I20080529000319 |
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