MEDICARE: FLORIDA SELGA BASILIO M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician	028720	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	306087	OTHER	GA	WELLCARE
2	52236043	OTHER	GA	BCBS GA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000327137E	OTHER	GA	PEACH STATE HEALTH PLAN
5	60024312	OTHER	AL	BCBS AL

General Provider Information

NPI Number	:	1861527103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORIDA SELGA BASILIO M.D.

Provider Business Mailing Address
First Line	:	1519 13TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1908
Country	:	US
Telephone Number	:	706-576-5570
Fax Number	:	706-576-4049

Provider Business Practice Location Address
First Line	:	1519 13TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1908
Country	:	US
Telephone Number	:	706-576-5570
Fax Number	:	706-576-4049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/13/2014

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