Brandon Medical Center | |
122 S Moon Ave Brandon FL 33511-5110 | |
(813) 502-6430 | |
Not Available |
Full Name | Brandon Medical Center |
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Speciality | General Practice |
Location | 122 S Moon Ave, Brandon, Florida |
Authorized Official Name and Position | Cindy Kilgore (OWNER) |
Authorized Official Contact | 8135026430 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Brandon Medical Center 122 S Moon Ave Brandon FL 33511-5110 Ph: (813) 502-6430 | Brandon Medical Center 122 S Moon Ave Brandon FL 33511-5110 Ph: (813) 502-6430 |
NPI Number | 1306396304 |
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Provider Enumeration Date | 10/13/2016 |
Last Update Date | 10/13/2016 |
Medicare PECOS PAC ID | 2163708611 |
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Medicare Enrollment ID | O20170417001698 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306396304 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | John Madison Kilgore |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1518140128 PECOS PAC ID: 6709162258 Enrollment ID: I20170417001740 |
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