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26286 Us Highway 19 N Ste B Clearwater FL 33761-4506 | |
| (727) 824-8100 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 26286 Us Highway 19 N Ste B, Clearwater, Florida |
| Authorized Official Name and Position | Edward Kucher (CHIEF REGULATORY OFFICER) |
| Authorized Official Contact | 7278248100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
14100 58th St N Ste 100 Clearwater FL 33760-9900 Ph: (727) 824-8181 | 26286 Us Highway 19 N Ste B Clearwater FL 33761-4506 Ph: (727) 824-8100 |
| NPI Number | 1194282756 |
|---|---|
| Provider Enumeration Date | 03/01/2019 |
| Last Update Date | 12/24/2024 |
| Medicare PECOS PAC ID | 8527961028 |
|---|---|
| Medicare Enrollment ID | O20190516000182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194282756 | NPI | - | NPPES |
| 029565530 | Medicaid | FL | |
| 029565529 | Medicaid | FL |
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