| Neurologic Consultants, Pa | |
|
517 Riviera St Suite A Venice FL 34285-2827 | |
| (941) 412-1208 | |
| (941) 412-1248 |
| Full Name | Neurologic Consultants, Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 517 Riviera St, Venice, Florida |
| Authorized Official Name and Position | Jullius Ilao Ancheta (PRESIDENT/PHYSICIAN) |
| Authorized Official Contact | 9414121208 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurologic Consultants, Pa 517 Riviera St Suite A Venice FL 34285-2827 Ph: (941) 412-1208 | Neurologic Consultants, Pa 517 Riviera St Suite A Venice FL 34285-2827 Ph: (941) 412-1208 |
| NPI Number | 1124028915 |
|---|---|
| Provider Enumeration Date | 07/22/2005 |
| Last Update Date | 11/23/2009 |
| Medicare PECOS PAC ID | 5698946416 |
|---|---|
| Medicare Enrollment ID | O20110927000337 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124028915 | NPI | - | NPPES |
| 264553000 | Medicaid | FL | |
| 58680 | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | ME80512 (Florida) | Primary |
| Provider Name | Jullius I Ancheta |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225146350 PECOS PAC ID: 9133392848 Enrollment ID: I20111025000451 |
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