Healthcare Provider Details

I. General information

NPI: 1104135011
Provider Name (Legal Business Name): COLUMBUS MEDICAL WELLNESS CENTER 4U, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 ROOSEVELT BLVD
CLEARWATER FL
33760-3422
US

IV. Provider business mailing address

3081 ROOSEVELT BLVD
CLEARWATER FL
33760-3422
US

V. Phone/Fax

Practice location:
  • Phone: 813-857-2618
  • Fax:
Mailing address:
  • Phone: 813-857-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberME82686
License Number StateFL

VIII. Authorized Official

Name: DR. ANTONIO MONSON
Title or Position: OWNER
Credential: MD
Phone: 813-857-2618