Healthcare Provider Details

I. General information

NPI: 1558977926
Provider Name (Legal Business Name): OHI WEST MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 7TH ST S STE 350
ST PETERSBURG FL
33701-4732
US

IV. Provider business mailing address

3090 CARUSO CT STE 50
ORLANDO FL
32806-8510
US

V. Phone/Fax

Practice location:
  • Phone: 727-553-7474
  • Fax: 727-553-7472
Mailing address:
  • Phone: 407-481-7174
  • Fax: 321-843-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELE NAPIER
Title or Position: VP, REVENUE MANAGEMENT & CRO
Credential:
Phone: 321-841-3492