| Pilot Healthcare P.l. | |
|
3501 Health Center Blvd Suite 2230 Bonita Springs FL 34135-8127 | |
| (239) 992-7822 | |
| Not Available |
| Full Name | Pilot Healthcare P.l. |
|---|---|
| Speciality | Family Medicine |
| Location | 3501 Health Center Blvd, Bonita Springs, Florida |
| Authorized Official Name and Position | Bruce M Bridewell (PRESIDENT) |
| Authorized Official Contact | 2399927822 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pilot Healthcare P.l. 20791 Three Oaks Pkwy #1209 Estero FL 33929-3670 Ph: (239) 287-6383 | Pilot Healthcare P.l. 3501 Health Center Blvd Suite 2230 Bonita Springs FL 34135-8127 Ph: (239) 992-7822 |
| NPI Number | 1790968899 |
|---|---|
| Provider Enumeration Date | 12/11/2007 |
| Last Update Date | 03/15/2013 |
| Medicare PECOS PAC ID | 8820078850 |
|---|---|
| Medicare Enrollment ID | O20040721001011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790968899 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME51156 (Florida) | Primary |
| Provider Name | Bruce M Bridewell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144293044 PECOS PAC ID: 5395644298 Enrollment ID: I20040108000507 |
| Provider Name | Kelly Keller Ahmad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093148611 PECOS PAC ID: 5597990739 Enrollment ID: I20131024001258 |
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