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4422 E Columbus Drive Tampa FL 33605 | |
| (813) 384-4216 | |
| (813) 623-3730 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4422 E Columbus Drive, Tampa, Florida |
| Authorized Official Name and Position | Deanna Obregon (CEO) |
| Authorized Official Contact | 8133844161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4422 E Columbus Drive Tampa FL 33605 Ph: (813) 384-4216 | 4422 E Columbus Drive Tampa FL 33605 Ph: (813) 384-4216 |
| NPI Number | 1487687273 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 10/05/2021 |
| Certification Date | 10/05/2021 |
| Medicare PECOS PAC ID | 9335294321 |
|---|---|
| Medicare Enrollment ID | O20120209000599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487687273 | NPI | - | NPPES |
| 060650200 | Medicaid | FL | |
| 060650203 | Medicaid | FL | |
| 060650202 | Medicaid | FL | |
| 913334800 | Medicaid | FL | |
| 060650204 | Medicaid | FL |
| Provider Name | Ashit K Vijapura |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053367847 PECOS PAC ID: 2163418252 Enrollment ID: I20040423000317 |
| Provider Name | Endra Sookoor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386933158 PECOS PAC ID: 3577868934 Enrollment ID: I20160223000531 |
| Provider Name | Stephanie Anne Cook |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033967567 PECOS PAC ID: 0345787602 Enrollment ID: I20240805000459 |
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