Provider Demographics
NPI:1902905011
Name:OSPREY PHYSICAL MEDICINE CENTER LLC
Entity Type:Organization
Organization Name:OSPREY PHYSICAL MEDICINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJERCIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-966-2900
Mailing Address - Street 1:2111 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9668
Mailing Address - Country:US
Mailing Address - Phone:941-966-2900
Mailing Address - Fax:
Practice Address - Street 1:2111 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9668
Practice Address - Country:US
Practice Address - Phone:941-966-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7308261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU79303Medicare UPIN
FLK5269Medicare ID - Type Unspecified