| Revello Medical Center | |
|
5901 Webb Rd Tampa FL 33615-3219 | |
| (813) 888-8215 | |
| Not Available |
| Full Name | Revello Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 5901 Webb Rd, Tampa, Florida |
| Authorized Official Name and Position | Antonio Calvo (MANAGER) |
| Authorized Official Contact | 8138888215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revello Medical Center 5901 Webb Rd Tampa FL 33615-3219 Ph: (813) 888-8215 | Revello Medical Center 5901 Webb Rd Tampa FL 33615-3219 Ph: (813) 888-8215 |
| NPI Number | 1699940718 |
|---|---|
| Provider Enumeration Date | 04/29/2008 |
| Last Update Date | 04/29/2008 |
| Medicare PECOS PAC ID | 7315241783 |
|---|---|
| Medicare Enrollment ID | O20171009000791 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699940718 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | ME0035878 (Florida) | Primary |
| Provider Name | Richard Dennis Santiago |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1164466876 PECOS PAC ID: 3375719966 Enrollment ID: I20171110001329 |
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