Provider Demographics
NPI:1174745889
Name:AMERICAN INJURY CENTERS OF PORT CHARLOTTE INC
Entity type:Organization
Organization Name:AMERICAN INJURY CENTERS OF PORT CHARLOTTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-923-9533
Mailing Address - Street 1:4161 TAMIAMI TRL
Mailing Address - Street 2:# 104
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9204
Mailing Address - Country:US
Mailing Address - Phone:941-923-9533
Mailing Address - Fax:
Practice Address - Street 1:4161 TAMIAMI TRL
Practice Address - Street 2:# 104
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-923-9533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFEDERAL TAX ID