MEDICARE: INFANTS & YOUNG CHILDREN OF WEST CENTRAL FLORIDA 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1831489319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFANTS & YOUNG CHILDREN OF WEST CENTRAL FLORIDA INC

Provider Business Mailing Address
First Line	:	1308 W SLIGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5902
Country	:	US
Telephone Number	:	813-375-3980
Fax Number	:	813-375-3984

Provider Business Practice Location Address
First Line	:	1308 W SLIGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5902
Country	:	US
Telephone Number	:	813-375-3980
Fax Number	:	813-375-3984

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PAT GROSZ
Credential	:
Telephone Number	:	813-375-3980

Provider Enumeration Date	:	04/18/2011
Last Update Date	:	04/18/2011

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