MEDICARE: WEST FLORIDA MEDICAL ASSOCIATES, PA

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	261QR1300X	Rural Health Clinic/Center	ME0071085	FL

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

General Provider Information

NPI Number	:	1336287457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST FLORIDA MEDICAL ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	PO BOX 640573
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34464-0573
Country	:	US
Telephone Number	:	352-746-1558
Fax Number	:	352-746-3838

Provider Business Practice Location Address
First Line	:	10489 N FLORIDA AVE
Second Line	:
City	:	CITRUS SPRINGS
State	:	FL
Zip	:	34434-3268
Country	:	US
Telephone Number	:	352-489-2486
Fax Number	:	352-489-5786

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ALEX VILLACASTIN
Credential	:	MD
Telephone Number	:	352-489-2486

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	08/27/2008

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