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NPI Code Detail

MEDICARE: PHYSICIANS OF WINTER HAVEN LLC

MEDICARE: PHYSICIANS OF WINTER HAVEN 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
1261QA1903XAmbulatory Surgical Clinic/Center1246FL

Other Identifiers

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

General Provider Information

NPI Number : 1801811443
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIANS OF WINTER HAVEN LLC
Provider Business Mailing Address
First Line : 2400 DUNDEE RD
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33884-1166
Country : US
Telephone Number : 863-293-8471
Fax Number : 863-508-1390
Provider Business Practice Location Address
First Line : 2400 DUNDEE RD
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33884-1166
Country : US
Telephone Number : 863-293-8471
Fax Number : 863-508-1390
Authorized Official
Title or Position : VICE PRESIDENT & MEDICAL DIRECTOR
Name : DR. JORGE R VILLARREAL
Credential : M.D.
Telephone Number : 863-293-8471
Provider Enumeration Date : 07/13/2006
Last Update Date : 08/22/2020

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Directions to “PHYSICIANS OF WINTER HAVEN LLC ” Practice Location

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