| Sebastian Id Care Llc | |
|
7955 Bay St Suite 2 Sebastian FL 32958-3282 | |
| (313) 832-2590 | |
| Not Available |
| Full Name | Sebastian Id Care Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7955 Bay St, Sebastian, Florida |
| Authorized Official Name and Position | Aisha Thomas (OWNER) |
| Authorized Official Contact | 3138322590 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sebastian Id Care Llc 7955 Bay St Suite 2 Sebastian FL 32958-3282 Ph: (313) 832-2590 | Sebastian Id Care Llc 7955 Bay St Suite 2 Sebastian FL 32958-3282 Ph: (313) 832-2590 |
| NPI Number | 1497125413 |
|---|---|
| Provider Enumeration Date | 10/02/2015 |
| Last Update Date | 10/02/2015 |
| Medicare PECOS PAC ID | 0749580397 |
|---|---|
| Medicare Enrollment ID | O20151203001484 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497125413 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | ME115531 (Florida) | Primary |
| Provider Name | Patrice W Wadsworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760609960 PECOS PAC ID: 3971698820 Enrollment ID: I20071008000036 |
| Provider Name | Aisha Thomas-st. Cyr |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1619153541 PECOS PAC ID: 6800912932 Enrollment ID: I20140124001484 |
| Provider Name | George E Wadsworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013325448 PECOS PAC ID: 8426277880 Enrollment ID: I20140917000218 |
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