Provider Demographics
NPI:1538155197
Name:TREASURE COAST THORACIC SURGERY, P.A.
Entity type:Organization
Organization Name:TREASURE COAST THORACIC SURGERY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-581-5848
Mailing Address - Street 1:816 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4141
Mailing Address - Country:US
Mailing Address - Phone:772-581-5848
Mailing Address - Fax:772-581-5849
Practice Address - Street 1:816 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-4141
Practice Address - Country:US
Practice Address - Phone:772-581-5848
Practice Address - Fax:772-581-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373207000Medicaid
FL21810OtherFL BCBS GROUP
FL254440700Medicaid
330004682OtherMEDICARE RAILROAD ID
FL68633OtherDR M GREENE BLUE SHIELD
FL373207000Medicaid
K0353Medicare PIN
68633Medicare PIN
FL21810OtherFL BCBS GROUP
FL68633OtherDR M GREENE BLUE SHIELD
FL254440700Medicaid