| Rivers Edge Boutique Medicine Llc | |
|
5647 Main St Ste 1&2 New Port Richey FL 34652-2641 | |
| (727) 831-8376 | |
| Not Available |
| Full Name | Rivers Edge Boutique Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5647 Main St Ste 1&2, New Port Richey, Florida |
| Authorized Official Name and Position | Tracy Greene (OWNER) |
| Authorized Official Contact | 7273424955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rivers Edge Boutique Medicine Llc 5647 Main St Ste 1&2 New Port Richey FL 34652-2641 Ph: (727) 831-8376 | Rivers Edge Boutique Medicine Llc 5647 Main St Ste 1&2 New Port Richey FL 34652-2641 Ph: (727) 831-8376 |
| NPI Number | 1033970454 |
|---|---|
| Provider Enumeration Date | 01/22/2024 |
| Last Update Date | 01/22/2024 |
| Medicare PECOS PAC ID | 0749625242 |
|---|---|
| Medicare Enrollment ID | O20240223002343 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033970454 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Tracy L Greene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700193737 PECOS PAC ID: 4880887645 Enrollment ID: I20140820002501 |
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