MEDICARE: SYNERGIC HEALTHCARE SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center
2	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033247580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGIC HEALTHCARE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	PO BOX 15490
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85267-5490
Country	:	US
Telephone Number	:	318-424-4008
Fax Number	:	855-230-1466

Provider Business Practice Location Address
First Line	:	11969 SHELDON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3644
Country	:	US
Telephone Number	:	813-925-1903
Fax Number	:	813-749-8370

Authorized Official
Title or Position	:	CEO
Name	:	DARON G DIECIDUE
Credential	:	MD
Telephone Number	:	813-925-1903

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	12/09/2024

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Directions to “SYNERGIC HEALTHCARE SOLUTIONS LLC ” Practice Location

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