Healthcare Provider Details

I. General information

NPI: 1164560124
Provider Name (Legal Business Name): WEST FLORIDA MEDICAL ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 N FLORIDA AVE
HERNANDO FL
34442
US

IV. Provider business mailing address

PO BOX 640573
BEVERLY HILLS FL
34464-0573
US

V. Phone/Fax

Practice location:
  • Phone: 352-637-2550
  • Fax: 352-637-2551
Mailing address:
  • Phone: 352-746-1558
  • Fax: 352-746-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberME0050533
License Number StateFL

VIII. Authorized Official

Name: DR. SHIRISHKUMAR G PATEL
Title or Position: PHYSICIAN
Credential: MD
Phone: 352-637-2550