Ddsom | |
4502 Cortez Rd W Ste 204 Bradenton FL 34210-3124 | |
(941) 761-1800 | |
Not Available |
Full Name | Ddsom |
---|---|
Speciality | Internal Medicine |
Location | 4502 Cortez Rd W Ste 204, Bradenton, Florida |
Authorized Official Name and Position | Rimantas Zalepuga (MEMBER) |
Authorized Official Contact | 9417611800 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Ddsom Po Box 15089 Bradenton FL 34280-5089 Ph: (941) 761-1800 | Ddsom 4502 Cortez Rd W Ste 204 Bradenton FL 34210-3124 Ph: (941) 761-1800 |
NPI Number | 1174655211 |
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Provider Enumeration Date | 03/12/2007 |
Last Update Date | 08/11/2021 |
Medicare PECOS PAC ID | 1951387158 |
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Medicare Enrollment ID | O20040628001253 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174655211 | NPI | - | NPPES |
DC1249 | Other | FL | RAIL ROAD MEDICARE |
6102336 | Other | FL | CIGNA |
271367500 | Medicaid | FL | |
74735 | Other | FL | BCBS |
9751349 | Other | FL | GHI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | ME85682 (Florida) | Primary |
Provider Name | Rimantas Zalepuga |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1316977499 PECOS PAC ID: 7517943723 Enrollment ID: I20040628001453 |
Provider Name | Bruce W Trotman |
---|---|
Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1821093576 PECOS PAC ID: 6305824285 Enrollment ID: I20040708000372 |
Provider Name | Silvio S. Tanev |
---|---|
Provider Type | Practitioner - Pathology |
Provider Identifiers | NPI Number: 1093745341 PECOS PAC ID: 1658384169 Enrollment ID: I20060731000411 |
Provider Name | Staci Thompson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982821757 PECOS PAC ID: 8325121999 Enrollment ID: I20080206000287 |
Provider Name | Sara Aileen Regino |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497389050 PECOS PAC ID: 8426479429 Enrollment ID: I20200529001393 |
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