Healthcare Provider Details

I. General information

NPI: 1083647010
Provider Name (Legal Business Name): HELIOS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3262 COVE BEND DR
TAMPA FL
33613-2752
US

IV. Provider business mailing address

3262 COVE BEND DR
TAMPA FL
33613-2752
US

V. Phone/Fax

Practice location:
  • Phone: 813-631-0102
  • Fax: 813-631-9198
Mailing address:
  • Phone: 813-631-0102
  • Fax: 813-631-9198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME69102
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME69102
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL A WEITZNER
Title or Position: PRESIDENT
Credential: MD
Phone: 813-631-0102