| South Tampa Medical Group Pa | |
|
206 2nd St E Bradenton FL 34208-1042 | |
| (941) 746-5111 | |
| Not Available |
| Full Name | South Tampa Medical Group Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 206 2nd St E, Bradenton, Florida |
| Authorized Official Name and Position | Henry J Weiss (OWNER PHYSICAN) |
| Authorized Official Contact | 3525168991 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Tampa Medical Group Pa 340 Sapphire Lake Dr Unit 101 Bradenton FL 34209-3445 Ph: (352) 516-8991 | South Tampa Medical Group Pa 206 2nd St E Bradenton FL 34208-1042 Ph: (941) 746-5111 |
| NPI Number | 1588718860 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 05/05/2022 |
| Medicare PECOS PAC ID | 1355306036 |
|---|---|
| Medicare Enrollment ID | O20041122000774 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588718860 | NPI | - | NPPES |
| O9089 | Other | FL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Henry Weiss |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831149756 PECOS PAC ID: 9335104017 Enrollment ID: I20100806000615 |
| Provider Name | Serena M Chero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659786093 PECOS PAC ID: 5890913602 Enrollment ID: I20140820000196 |
| Provider Name | Valerie Smith Ismail |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316596489 PECOS PAC ID: 0749674554 Enrollment ID: I20220302000524 |
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