MEDICARE: EXODUS WOMEN'S CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902209257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXODUS WOMEN'S CENTER, INC.

Provider Business Mailing Address
First Line	:	888 S PARSONS AVE
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-6007
Country	:	US
Telephone Number	:	813-684-2229
Fax Number	:	813-654-1384

Provider Business Practice Location Address
First Line	:	4503 N 22ND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-6201
Country	:	US
Telephone Number	:	813-684-2229
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MS. LINDA S. MAYO
Credential	:
Telephone Number	:	813-684-2229

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	06/02/2019

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