| |
8730 Fountain Ave Tampa FL 33615-2802 | |
(813) 885-6001 | |
(813) 885-6874 |
Full Name | |
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Speciality | Clinic/Center |
Location | 8730 Fountain Ave, Tampa, Florida |
Authorized Official Name and Position | William Lichter (PRESIDENT) |
Authorized Official Contact | 8138856001 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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8730 Fountain Ave Tampa FL 33615-2802 Ph: (813) 885-6001 | 8730 Fountain Ave Tampa FL 33615-2802 Ph: (813) 885-6001 |
NPI Number | 1285714394 |
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Provider Enumeration Date | 10/16/2006 |
Last Update Date | 04/01/2013 |
Medicare PECOS PAC ID | 1850538901 |
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Medicare Enrollment ID | O20130508000363 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285714394 | NPI | - | NPPES |
380716900 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | CH6815 (Florida) | Primary |
Provider Name | William I Lichter |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1396704250 PECOS PAC ID: 5294831103 Enrollment ID: I20070509000124 |
Provider Name | Cameron M Banks |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1255748968 PECOS PAC ID: 4880913789 Enrollment ID: I20150427001447 |
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