Biocell Regenerative Medicine Llc | |
3605 Madaca Ln Tampa FL 33618-2048 | |
(813) 443-8222 | |
Not Available |
Full Name | Biocell Regenerative Medicine Llc |
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Speciality | Family Medicine |
Location | 3605 Madaca Ln, Tampa, Florida |
Authorized Official Name and Position | Jonathan Urshan (OWNER, AUTHORIZED OFFICIAL) |
Authorized Official Contact | 8134438222 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Biocell Regenerative Medicine Llc 3605 Madaca Ln Tampa FL 33618-2048 Ph: (813) 443-8222 | Biocell Regenerative Medicine Llc 3605 Madaca Ln Tampa FL 33618-2048 Ph: (813) 443-8222 |
NPI Number | 1841818705 |
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Provider Enumeration Date | 07/08/2020 |
Last Update Date | 07/24/2020 |
Medicare PECOS PAC ID | 5890111215 |
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Medicare Enrollment ID | O20200817001701 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841818705 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Jessica Simone |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114457876 PECOS PAC ID: 8123392511 Enrollment ID: I20170925000021 |
Provider Name | Daniel Alex Manning |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1740764257 PECOS PAC ID: 6507199486 Enrollment ID: I20190607001399 |
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