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8200 Beckett Park Dr Ste 120 West Chester OH 45069-9310 | |
| (800) 991-7630 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 8200 Beckett Park Dr Ste 120, West Chester, Ohio |
| Authorized Official Name and Position | Patrick Bengston (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 7272144622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8924 Arabella Ln Seminole FL 33777-2649 Ph: (727) 214-4622 | 8200 Beckett Park Dr Ste 120 West Chester OH 45069-9310 Ph: (800) 991-7630 |
| NPI Number | 1851145759 |
|---|---|
| Provider Enumeration Date | 04/16/2024 |
| Last Update Date | 01/09/2025 |
| Medicare PECOS PAC ID | 2860938198 |
|---|---|
| Medicare Enrollment ID | O20240723003682 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851145759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Kelcy Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376176784 PECOS PAC ID: 3072942499 Enrollment ID: I20200407000955 |
| Provider Name | Alicia Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902410111 PECOS PAC ID: 5294155479 Enrollment ID: I20201013002076 |
| Provider Name | Patrick Bengston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770177446 PECOS PAC ID: 9931515285 Enrollment ID: I20240723003817 |
| Provider Name | Kavita Talati |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447919832 PECOS PAC ID: 0840681664 Enrollment ID: I20240822004734 |
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