MEDICARE: THE GITTENS CLINIC INC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		FL

General Provider Information

NPI Number	:	1457895625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GITTENS CLINIC INC

Provider Business Mailing Address
First Line	:	789 SW FEDERAL HWY STE 212
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2962
Country	:	US
Telephone Number	:	772-288-4111
Fax Number	:	772-905-3336

Provider Business Practice Location Address
First Line	:	789 SW FEDERAL HWY STE 212
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2962
Country	:	US
Telephone Number	:	772-288-4111
Fax Number	:	772-905-3336

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARL GITTENS
Credential	:	MD
Telephone Number	:	772-215-5905

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	07/22/2017

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Directions to “THE GITTENS CLINIC INC ” Practice Location

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