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BRADENTON SURGICAL GROUP PA NPI 1164418182


NPI Information

NPI: 1164418182
Provider Name: BRADENTON SURGICAL GROUP PA
Classification: Surgery - 2086S0129X
Entity Type: Organization

Specialization: Vascular Surgery

CLIA Number: 10D1063847

Address:
200 3RD AVE W
STE 110
BRADENTON, FL
ZIP 34205
Phone: (941) 744-2700
Get Directions

BRADENTON SURGICAL GROUP PA is a vascular surgery surgery in Bradenton, FL. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. BRADENTON SURGICAL GROUP PA NPI is 1164418182. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

200 3RD AVE W
STE 110
BRADENTON, FL
ZIP 34205-626
Phone: (941) 744-2700
Fax: (941) 744-2705

The provider's authorized official is Gary M Bunch .
The authorized official title is Owner and has the following contact phone number (941) 744-2700.

The CLIA number assigned to this NPI record is 10D1063847 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/26/2005 and was last updated on 4/20/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12086S0129XSurgeryVascular Surgery=========FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
194850MEDICARE PINFLORIDA
2CK2566OTHERFLORIDARAIL ROAD MEDICARE
394850OTHERFLORIDABCBS
47385373OTHERFLORIDAAETNA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.