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NPI Code Detail

MEDICARE: MONTE EDWARDS PAC

MEDICARE: MONTE EDWARDS PAC
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
1363AM0700XMedical Physician AssistantPA1806FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y01AAOTHERFLBCBS FL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205820511
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONTE EDWARDS PAC
Provider Business Mailing Address
First Line : 605 LAMAR AVE
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34601-3211
Country : US
Telephone Number : 352-799-5411
Fax Number : 352-544-2713
Provider Business Practice Location Address
First Line : 605 LAMAR AVE
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34601-3211
Country : US
Telephone Number : 352-799-5411
Fax Number : 352-544-2713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 09/22/2014

Similar Medicare Providers

1508869330 — MRS. ANNA K ALLEN ARNP
Practice Location Address:
605 LAMAR AVE
BROOKSVILLE, FL
34601-3211
Practice Phone: 352-799-5411
Practice Fax: 352-544-2713
1861486177 — MALCOLM R FRASER MD
Practice Location Address:
605 LAMAR AVE
BROOKSVILLE, FL
34601-3211
Practice Phone: 352-799-5411
Practice Fax: 352-544-2713
1114911328 — GARY L CLARK PA C
Practice Location Address:
605 LAMAR AVE
BROOKSVILLE, FL
34601-3211
Practice Phone: 352-799-5411
Practice Fax: 352-544-2713
1982690681 — MR. KENNETH D. GOOGE PA-C
Practice Location Address:
605 LAMAR AVENUE
BROOKSVILLE, FL
34601-3211
Practice Phone: 352-796-9990
Practice Fax: 352-796-2226
1144273889 — JAMES R CUMMINGS MD PA
Practice Location Address:
605 LAMAR AVE
BROOKSVILLE, FL
34601-3211
Practice Phone: 352-796-9990
Practice Fax: 352-796-2226
1447290952 — PHYSICIAN PARTNERS NETWORK PA
Practice Location Address:
605 LAMAR AVE
BROOKSVILLE, FL
34601-3211
Practice Phone: 352-796-9990
Practice Fax: 352-796-2226

Directions to “ MONTE EDWARDS PAC” Practice Location

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