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General NPI Number Information
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NPI Number | 1346854320
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Entity Type | Organization
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Legal Business Name | WILCO CIVIL, D.O. PLLC
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Dates
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Enumeration Date | 09/07/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 18598 MILTON KEYNES CT
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City | LAND O LAKES
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State | FL
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Zip | 34638-2202
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Country | US
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Telephone | 813-403-9096
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Fax |
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Provider Business Mailing Address
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Address Line | 5230 LAND O LAKES BLVD #2873
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City | LAND O LAKES
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State | FL
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Zip | 34639
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | DR. WILCO CIVIL
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Credential | DO
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Telephone | 813-403-9096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM1102X
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Taxonomy Name | Military Outpatient Operational (Transportable) Component Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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