MEDICARE: SELWYN ST LOUIS 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	253Z00000X	In Home Supportive Care Agency	231132	FL
2	261QD1600X	Developmental Disabilities Clinic/Center
3	251E00000X	Home Health Agency

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962637736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELWYN ST LOUIS INC

Provider Business Mailing Address
First Line	:	4100 W KENNEDY BLVD STE 328
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2290
Country	:	US
Telephone Number	:	813-609-1390
Fax Number	:	813-609-1392

Provider Business Practice Location Address
First Line	:	4100 W KENNEDY BLVD STE 328
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2290
Country	:	US
Telephone Number	:	813-609-1390
Fax Number	:	813-609-1392

Authorized Official
Title or Position	:	DIRECTOR/CEO
Name	:	MR. CHESKEL SPITZER
Credential	:
Telephone Number	:	813-609-1390

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	12/11/2024

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