| Bywater Mental Health Pllc | |
|
10225 Ulmerton Rd Ste 3a Largo FL 33771-3519 | |
| (727) 371-0079 | |
| Not Available |
| Full Name | Bywater Mental Health Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 10225 Ulmerton Rd Ste 3a, Largo, Florida |
| Authorized Official Name and Position | Gerald Lee Randall (OWNER) |
| Authorized Official Contact | 7273710079 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bywater Mental Health Pllc 10225 Ulmerton Rd Ste 3a Largo FL 33771-3519 Ph: (727) 371-0079 | Bywater Mental Health Pllc 10225 Ulmerton Rd Ste 3a Largo FL 33771-3519 Ph: (727) 371-0079 |
| NPI Number | 1912576695 |
|---|---|
| Provider Enumeration Date | 06/17/2021 |
| Last Update Date | 06/17/2021 |
| Certification Date | 06/17/2021 |
| Medicare PECOS PAC ID | 7911396023 |
|---|---|
| Medicare Enrollment ID | O20211111000517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912576695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Gerald L Randall |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184032740 PECOS PAC ID: 2860753829 Enrollment ID: I20180308000630 |
| Provider Name | Zachary Zimko |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437508561 PECOS PAC ID: 6507294782 Enrollment ID: I20200323000883 |
| Provider Name | Christie Daloiso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518651751 PECOS PAC ID: 2860834918 Enrollment ID: I20240521003918 |
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