| Healthpath Medical Center, Llc | |
|
201 Nw 82nd Ave Ste 203b Plantation FL 33324-1854 | |
| (954) 472-7169 | |
| (954) 473-3313 |
| Full Name | Healthpath Medical Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 201 Nw 82nd Ave Ste 203b, Plantation, Florida |
| Authorized Official Name and Position | Robert P. Hostler (DIRECTOR/CEO/PRESIDENT) |
| Authorized Official Contact | 7033597200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthpath Medical Center, Llc 201 Nw 82nd Ave Ste 203b Plantation FL 33324-1854 Ph: (954) 472-7169 | Healthpath Medical Center, Llc 201 Nw 82nd Ave Ste 203b Plantation FL 33324-1854 Ph: (954) 472-7169 |
| NPI Number | 1053754028 |
|---|---|
| Provider Enumeration Date | 04/09/2013 |
| Last Update Date | 10/21/2020 |
| Medicare PECOS PAC ID | 8729212865 |
|---|---|
| Medicare Enrollment ID | O20131003000587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053754028 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 23433 (Florida) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | HCC9758 (Florida) | Primary |
| Provider Name | Regina B Portnova |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114908373 PECOS PAC ID: 4587620885 Enrollment ID: I20041208000754 |
| Provider Name | Juan O Bravo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558470443 PECOS PAC ID: 7315952918 Enrollment ID: I20060221000130 |
| Provider Name | Princess M Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043383722 PECOS PAC ID: 3476590811 Enrollment ID: I20080812000674 |
| Provider Name | Sheryl M Raikes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932433356 PECOS PAC ID: 9739229675 Enrollment ID: I20091228000184 |
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