| Bennett W Mcallister Md Pa | |
|
4161 Tamiami Trl Ste 304d Port Charlotte FL 33952-9254 | |
| (941) 625-5895 | |
| (941) 625-1047 |
| Full Name | Bennett W Mcallister Md Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 4161 Tamiami Trl Ste 304d, Port Charlotte, Florida |
| Authorized Official Name and Position | Bennett William Mcallister (OWNER) |
| Authorized Official Contact | 9416255895 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bennett W Mcallister Md Pa Po Box 512139 Punta Gorda FL 33951-2139 Ph: (941) 205-2417 | Bennett W Mcallister Md Pa 4161 Tamiami Trl Ste 304d Port Charlotte FL 33952-9254 Ph: (941) 625-5895 |
| NPI Number | 1104154053 |
|---|---|
| Provider Enumeration Date | 12/03/2009 |
| Last Update Date | 02/26/2024 |
| Certification Date | 02/26/2024 |
| Medicare PECOS PAC ID | 3678617347 |
|---|---|
| Medicare Enrollment ID | O20100218000400 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104154053 | NPI | - | NPPES |
| 001284200 | Medicaid | FL | |
| 114514100 | Medicaid | FL |
| Provider Name | Thomas Albert Willingham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285678805 PECOS PAC ID: 9436155322 Enrollment ID: I20061017000432 |
| Provider Name | Bennett W Mcallister |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275704157 PECOS PAC ID: 6002953247 Enrollment ID: I20091021000303 |
| Provider Name | Mizyl Frances Damayo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518057264 PECOS PAC ID: 3072614452 Enrollment ID: I20121113000270 |
| Provider Name | Ruth Sosa-jimenez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396327086 PECOS PAC ID: 7416358296 Enrollment ID: I20210630003096 |
| Provider Name | Belinda Alma |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427101773 PECOS PAC ID: 1658716667 Enrollment ID: I20240229002707 |
| Provider Name | Randy M Cisne |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679638365 PECOS PAC ID: 8224474002 Enrollment ID: I20240314004086 |
| Provider Name | Candis L Jackson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104004746 PECOS PAC ID: 2668814625 Enrollment ID: I20240522004291 |
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