| Diversity Health Center Of Tampa Bay | |
|
4302 N Habana Ave Ste 200 Tampa FL 33607-6368 | |
| (813) 518-0881 | |
| (813) 518-0882 |
| Full Name | Diversity Health Center Of Tampa Bay |
|---|---|
| Speciality | Internal Medicine |
| Location | 4302 N Habana Ave Ste 200, Tampa, Florida |
| Authorized Official Name and Position | David W Lyter (OWNER) |
| Authorized Official Contact | 8135180881 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diversity Health Center Of Tampa Bay 4302 N Habana Ave Ste 200 Tampa FL 33607-6368 Ph: (813) 518-0881 | Diversity Health Center Of Tampa Bay 4302 N Habana Ave Ste 200 Tampa FL 33607-6368 Ph: (813) 518-0881 |
| NPI Number | 1912410895 |
|---|---|
| Provider Enumeration Date | 11/14/2017 |
| Last Update Date | 07/15/2019 |
| Medicare PECOS PAC ID | 0244591360 |
|---|---|
| Medicare Enrollment ID | O20180305002394 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912410895 | NPI | - | NPPES |
| 023374100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME79149 (Florida) | Primary |
| Provider Name | David Wayne Lyter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659320158 PECOS PAC ID: 2769496157 Enrollment ID: I20060206000874 |
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