| Lourdes L Virtusio M D Family Practice Clinic Inc | |
|
2102 Town Street Pensacola FL 32526 | |
| (850) 432-4745 | |
| (850) 434-0395 |
| Full Name | Lourdes L Virtusio M D Family Practice Clinic Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2102 Town Street, Pensacola, Florida |
| Authorized Official Name and Position | Lourdes L Virtusio (OWNER) |
| Authorized Official Contact | 8504324745 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lourdes L Virtusio M D Family Practice Clinic Inc 2102 Town Street Pensacola FL 32526 Ph: (850) 432-4745 | Lourdes L Virtusio M D Family Practice Clinic Inc 2102 Town Street Pensacola FL 32526 Ph: (850) 432-4745 |
| NPI Number | 1831365972 |
|---|---|
| Provider Enumeration Date | 05/07/2008 |
| Last Update Date | 11/29/2010 |
| Medicare PECOS PAC ID | 6204023898 |
|---|---|
| Medicare Enrollment ID | O20101208000785 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831365972 | NPI | - | NPPES |
| 251986100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lourdes Virtusio |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144249012 PECOS PAC ID: 8729275318 Enrollment ID: I20101208000835 |
| Provider Name | Ryan Allen Bianco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740640200 PECOS PAC ID: 1658679402 Enrollment ID: I20160412002832 |
| Provider Name | Jonathan Demarcus Stromas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396205977 PECOS PAC ID: 8527439173 Enrollment ID: I20230119000740 |
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