Healthcare Provider Details

I. General information

NPI: 1003385055
Provider Name (Legal Business Name): BETHSAIDA HEALTHCARE SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2986 COUNTY ROAD 503
WILDWOOD FL
34785-8013
US

IV. Provider business mailing address

910 OLD CAMP RD STE 144
THE VILLAGES FL
32162-5609
US

V. Phone/Fax

Practice location:
  • Phone: 352-753-2224
  • Fax: 353-753-0833
Mailing address:
  • Phone: 352-753-2224
  • Fax: 353-753-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FELIX C AGBO
Title or Position: OWNER
Credential: MD
Phone: 352-753-2224