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16554 N Dale Mabry Hwy Tampa FL 33618-1325 | |
| (813) 968-7188 | |
| (813) 715-9802 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 16554 N Dale Mabry Hwy, Tampa, Florida |
| Authorized Official Name and Position | Cindi Germond (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Contact | 8137159802 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
16554 N Dale Mabry Hwy Tampa FL 33618-1325 Ph: (813) 968-7188 | 16554 N Dale Mabry Hwy Tampa FL 33618-1325 Ph: (813) 968-7188 |
| NPI Number | 1922346030 |
|---|---|
| Provider Enumeration Date | 01/24/2013 |
| Last Update Date | 01/24/2013 |
| Medicare PECOS PAC ID | 5991091803 |
|---|---|
| Medicare Enrollment ID | O20160901000229 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922346030 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | ME0055695 (Florida) | Primary |
| Provider Name | Bruce J Edson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528129913 PECOS PAC ID: 4183635865 Enrollment ID: I20060509000593 |
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