| Simon Groseclose Dc Llc | |
|
2020 Ashley Oaks Cir Ste 101 Wesley Chapel FL 33544-6410 | |
| (813) 358-1994 | |
| Not Available |
| Full Name | Simon Groseclose Dc Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2020 Ashley Oaks Cir Ste 101, Wesley Chapel, Florida |
| Authorized Official Name and Position | Simon Groseclose (PRESIDENT) |
| Authorized Official Contact | 8139950984 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Simon Groseclose Dc Llc 2020 Ashley Oaks Cir Ste 101 Wesley Chapel FL 33544-6410 Ph: (813) 388-2935 | Simon Groseclose Dc Llc 2020 Ashley Oaks Cir Ste 101 Wesley Chapel FL 33544-6410 Ph: (813) 358-1994 |
| NPI Number | 1275073710 |
|---|---|
| Provider Enumeration Date | 03/02/2017 |
| Last Update Date | 01/28/2020 |
| Medicare PECOS PAC ID | 3779850912 |
|---|---|
| Medicare Enrollment ID | O20170518002111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275073710 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Joey S Ancheta |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841235926 PECOS PAC ID: 1153394291 Enrollment ID: I20060502000616 |
| Provider Name | Simon Groseclose |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1215211412 PECOS PAC ID: 3072744887 Enrollment ID: I20140320000230 |
| Provider Name | Kelly Marie Gordon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194349019 PECOS PAC ID: 8628488038 Enrollment ID: I20201112002836 |
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