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733 E Olympia Ave Punta Gorda FL 33950-3841 | |
| (941) 637-2474 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 733 E Olympia Ave, Punta Gorda, Florida |
| Authorized Official Name and Position | Paula Lalor (DIRECTOR/DELEGATED OFFICIAL) |
| Authorized Official Contact | 6292153953 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
809 E Marion Ave Punta Gorda FL 33950-3819 Ph: (941) 639-3131 | 733 E Olympia Ave Punta Gorda FL 33950-3841 Ph: (941) 637-2474 |
| NPI Number | 1659310985 |
|---|---|
| Provider Enumeration Date | 06/05/2006 |
| Last Update Date | 12/14/2021 |
| Certification Date | 12/14/2021 |
| Medicare PECOS PAC ID | 4981656212 |
|---|---|
| Medicare Enrollment ID | O20090616000159 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659310985 | NPI | - | NPPES |
| 010027700 | Medicaid | FL | |
| 529 | Other | FL | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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