Dr Kimberly Ann Bruno-de La Mata, MD | |
13506 Summerport Village Pkwy, #341, Windermere, FL 34786-7366 | |
(865) 363-3330 | |
Not Available |
Full Name | Dr Kimberly Ann Bruno-de La Mata |
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Gender | Female |
Speciality | Emergency Medicine |
Location | 13506 Summerport Village Pkwy, Windermere, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1548216419 | NPI | - | NPPES |
3856126 | Medicaid | TN | |
4103352 | Other | TN | BLUE CROSS |
P00284603 | Other | TN | RRGA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | ME101735 (Florida) | Primary |
Entity Name | Tri-cities Regional Emergency Physicians, Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1063950046 PECOS PAC ID: 3678859477 Enrollment ID: O20170410002399 |
Entity Name | App Of East Tennessee Ed Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1326695537 PECOS PAC ID: 6800127796 Enrollment ID: O20191007003318 |
Mailing Address | Practice Location Address |
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Dr Kimberly Ann Bruno-de La Mata, MD 1200 J D Anderson Dr, Morgantown, WV 26505-3494 Ph: (304) 598-1200 | Dr Kimberly Ann Bruno-de La Mata, MD 13506 Summerport Village Pkwy, #341, Windermere, FL 34786-7366 Ph: (865) 363-3330 |
Dr. Mariano De La Mata, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 13506 Summerport Village Pkwy, #341, Windermere, FL 34786 Phone: 865-406-9069 | |
Dr. Brian Wiboon, DO Emergency Medicine Medicare: Medicare Enrolled Practice Location: 5143 Tildens Grove Blvd, Windermere, FL 34786 Phone: 407-656-9908 Fax: 407-656-9908 |