National Provider Identifier Database

MEDICAL PAVILION CLINC
Preferred Provider Organization

A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.


Contact Information

MEDICAL PAVILION CLINC
2525 HARBOR BLVD
SUITE 102
PORT CHARLOTTE, FL33952-5317
Phone: 941-629-9190
Fax: 941-625-2751
Website:
Specialty Taxonomy Code
* Preferred Provider Organization 305R00000X

* Indicates primary specialty

NPI Profile & details for MEDICAL PAVILION CLINC

NPI Number 1063671683
Legal business name
LBN
MEDICAL PAVILION CLINC
Authorized official DAVID BALLESTAS - (DOCTOR - OWNER)
Entity Organization
Organization subpart No
Enumeration date 06/09/2008
Last updated 06/09/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • FL License #: ME0044391
  • FL Medicaid: 0608916500

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for MEDICAL PAVILION CLINC

There are currently no reviews for MEDICAL PAVILION CLINC


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