=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679344394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHI WEST MEDICAL GROUP II LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2024
-----------------------------------------------------
Last Update Date | 02/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6233 ABBOTT STATION DR
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33542-4819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-778-0808
-----------------------------------------------------
Fax | 813-355-5078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38135 MARKET SQUARE DR
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33542-7505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-528-4907
-----------------------------------------------------
Fax | 813-377-1394
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOE DELATORRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-780-8440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------