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BURNT STORE FAMILY MEDICINE P L
NPI 1164739421
Family Medicine in Punta Gorda, FL

Active since September 08, 2010CLIA 10D1003368 · Waiver
100 MADRID BLVD, SUITE 513, PUNTA GORDA, FL 33950(941) 505-0974(941) 505-8517 Get Directions Write a Review

NPPES record last updated: June 23, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Burnt Store Family Medicine P L NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BURNT STORE FAMILY MEDICINE P L (NPI 1164739421) is a healthcare organization registered as a family medicine in Punta Gorda, Florida and active in the NPI registry since September 2010. The organization holds a CLIA Waiver certificate valid through August 27, 2026 and lists Gordon Wang, Owner, as its authorized official.

NPPES Registry Identity

NPI1164739421
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBURNT STORE FAMILY MEDICINE P L
Location Address100 MADRID BLVD, SUITE 513Punta Gorda, FL 33950-7968
Mailing Address100 Madrid Blvd, Suite 513Punta Gorda, FL 33950-7968 · (941) 505-0974 · Fax (941) 505-8517
Phone(941) 505-0974
Fax(941) 505-8517
Organization SubpartNo
Authorized OfficialGordon WangOwner · (941) 505-0974
Enumeration DateSeptember 8, 2010
Last NPPES UpdateJune 23, 2011
✔ NPI 1164739421 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in FL · ME0072508
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
100 MADRID BLVD, Punta Gorda, FL 33950
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Other Identifiers 1

Medicare PINEZ857AFL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D1003368

Burnt Store Family Medicine LLC · Punta Gorda, FL
Active · expires Aug 27, 2026
CLIA Number10D1003368
Laboratory TypePhysician Office
Certificate Effective DateAugust 28, 2024
Certificate Expiration DateAugust 27, 2026
Laboratory DirectorGordon K. Wang
Laboratory Phone(941) 505-0974
Laboratory LocationBurnt Store Family Medicine LLC100 Madrid Blvd Ste 513, Punta Gorda, FL 33950
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RICARDO ARTHUR GAUTHIER AU.D.
Audiologist
100 MADRID BLVD, SUITE 214
PUNTA GORDA, FL 33950
Charlotte County (941) 505-0400
DR. GORDON K WANG MD
Family Medicine
100 MADRID BLVD, 513
PUNTA GORDA, FL 33950
Charlotte County (941) 505-0974
DR. MARILYN KAY LARKIN AUD
Audiologist
100 MADRID BLVD, STE 315
PUNTA GORDA, FL 33950
Charlotte County (941) 505-0400
DR. THOMAS W NOONE MD PA
Family Medicine
100 MADRID BLVD, 113
PUNTA GORDA, FL 33950
Charlotte County (941) 205-5205
HARBOR AUDIOLOGY, P.A.
Audiologist
100 MADRID BLVD, SUITE 214
PUNTA GORDA, FL 33950
Charlotte County (941) 505-0400
DR. EDWARD SWANTON BENDER DC
Chiropractor
100 MADRID BLVD, SUITE 311
PUNTA GORDA, FL 33950
Charlotte County (941) 637-6090
THERAPEUTIC WELLNESS CENTER
Massage Therapist
100 MADRID BLVD, SUITE 411
PUNTA GORDA, FL 33950
Charlotte County (941) 833-3344
CHESSIE PRYOR BAZZO OT
Occupational Therapist
100 MADRID BLVD
PUNTA GORDA, FL 33950
Charlotte County (941) 681-2064

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Burnt Store Family Medicine P L's NPI number?

The NPI number for Burnt Store Family Medicine P L is 1164739421. It was assigned to this organization in the NPPES registry on September 8, 2010.

Where is Burnt Store Family Medicine P L located?

Burnt Store Family Medicine P L is located at 100 Madrid Blvd Suite 513, Punta Gorda, FL 33950. The listed phone number is (941) 505-0974.

What is Burnt Store Family Medicine P L's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Burnt Store Family Medicine P L hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1003368) is associated with this NPI, valid through August 27, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Burnt Store Family Medicine P L was last updated on June 23, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.