| Liveactive Multispecialty Physician Group Tampa | |
|
12440 Cortez Blvd Brooksville FL 34613-2628 | |
| (913) 549-3884 | |
| Not Available |
| Full Name | Liveactive Multispecialty Physician Group Tampa |
|---|---|
| Speciality | Hospitalist |
| Location | 12440 Cortez Blvd, Brooksville, Florida |
| Authorized Official Name and Position | Shane Brethowr (CEO/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9135493884 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Liveactive Multispecialty Physician Group Tampa Po Box 1269 Bellevue NE 68005-1269 Ph: () - | Liveactive Multispecialty Physician Group Tampa 12440 Cortez Blvd Brooksville FL 34613-2628 Ph: (913) 549-3884 |
| NPI Number | 1891556049 |
|---|---|
| Provider Enumeration Date | 01/16/2024 |
| Last Update Date | 09/14/2024 |
| Medicare PECOS PAC ID | 7416390158 |
|---|---|
| Medicare Enrollment ID | O20240208004443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891556049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208M00000X | Hospitalist | (* (Not Available)) | Primary |
| Provider Name | Haseeb Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972701571 PECOS PAC ID: 4587788013 Enrollment ID: I20240208004470 |
| Provider Name | Jose Perez-montalvo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851721963 PECOS PAC ID: 9638489347 Enrollment ID: I20240320000722 |
| Provider Name | Ramiro Montemayor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467001982 PECOS PAC ID: 4587078407 Enrollment ID: I20240322002220 |
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