Gregorio S Santos Md Pa | |
6125 54th Ave N Ste B Kenneth City FL 33709-1830 | |
(727) 521-9467 | |
(727) 521-0416 |
Full Name | Gregorio S Santos Md Pa |
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Speciality | Clinic/Center |
Location | 6125 54th Ave N Ste B, Kenneth City, Florida |
Authorized Official Name and Position | Gregorio S Santos (OWNER) |
Authorized Official Contact | 7275219467 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Gregorio S Santos Md Pa 6125 54th Ave N Ste B Kenneth City FL 33709-1830 Ph: (727) 521-9467 | Gregorio S Santos Md Pa 6125 54th Ave N Ste B Kenneth City FL 33709-1830 Ph: (727) 521-9467 |
NPI Number | 1306156104 |
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Provider Enumeration Date | 10/14/2010 |
Last Update Date | 11/28/2012 |
Medicare PECOS PAC ID | 6507018678 |
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Medicare Enrollment ID | O20121219000078 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306156104 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | ME0072417 (Florida) | Primary |
Provider Name | Gregorio Samuel Santos |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1417060369 PECOS PAC ID: 9436119591 Enrollment ID: I20041013000437 |
Consultants In Infectious Diseases Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5670 54th Avenue North, Suite A-1, Kenneth City, FL 33709 Phone: 727-548-0260 Fax: 727-548-0270 |