Organization · NPI-2

Alligator Bay Inpatient Services LLC

Internal Medicine · Port Charlotte, FL

NPI number1740618248

StatusActive

Last updated in NPPESOct 22, 2013

Details

NPI: 1740618248
Entity type: Organization (NPI-2)
Legal business name: Alligator Bay Inpatient Services LLC
Organization subpart: No
Enumeration date: Oct 17, 2013
Last updated: Oct 22, 2013

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207R00000X	Internal Medicine	–	–	Yes
363L00000X	Nurse Practitioner	–	–
363A00000X	Physician Assistant	–	–

Practice location

21298 Olean Blvd
Port Charlotte, FL 33952-6705

Phone 469-401-2386 · Fax 214-712-2444

Mailing address

13737 Noel Rd
Ste 1600
Dallas, TX 75240-1331

Phone 469-401-2386 · Fax 214-712-2444

Authorized official

Gregory Byrne
President
4694012386

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