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1811 Shore Dr S S Pasadena FL 33707 | |
(727) 391-4100 | |
(727) 398-2067 |
Full Name | |
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Speciality | Family Medicine |
Location | 1811 Shore Dr S, S Pasadena, Florida |
Authorized Official Name and Position | Ehren Carine (PRESIDENT) |
Authorized Official Contact | 7273914100 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2410 Northside Dr Clearwater FL 33761-2236 Ph: (727) 499-0356 | 1811 Shore Dr S S Pasadena FL 33707 Ph: (727) 391-4100 |
NPI Number | 1811484751 |
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Provider Enumeration Date | 04/17/2018 |
Last Update Date | 07/12/2018 |
Medicare PECOS PAC ID | 3870849441 |
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Medicare Enrollment ID | O20180712000821 |
Identifier | Type | State | Issuer |
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1811484751 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | OS (Florida) | Primary |
Provider Name | Ehren Carine |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1174889752 PECOS PAC ID: 0941506935 Enrollment ID: I20161206001119 |