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General NPI Number Information
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NPI Number | 1013241801
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Entity Type | Organization
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Legal Business Name | SENIOR HOUSE CALL SVC INC
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 1515 9TH ST W
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City | PALMETTO
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State | FL
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Zip | 34221-4463
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Country | US
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Telephone | 941-891-5643
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Fax | 941-981-5644
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Provider Business Mailing Address
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Address Line | 1515 9TH STREET W
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City | PALMETTO
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State | FL
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Zip | 34221-4463
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Country | US
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Telephone | 941-981-5642
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Fax | 941-981-5644
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN A JOHNSON
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Credential | MD
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Telephone | 941-981-5643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME23667
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License Number State | FL
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