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General NPI Number Information
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NPI Number | 1497255814
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Entity Type | Organization
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Legal Business Name | PLANTATION MEDICAL CARE, PA
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 9030 W FORT ISLAND TRL STE 11B
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429
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Country | US
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Telephone | 352-651-5127
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Fax | 352-651-5129
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Provider Business Mailing Address
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Address Line | 9030 W FORT ISLAND TRL STE 11B
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-2415
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Country | US
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Telephone | 352-651-5127
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Fax | 352-651-5129
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ADRIANNE ASHMORE HESS
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Credential |
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Telephone | 352-651-5127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OS4310
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | OS-0004310
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License Number State | FL
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