| Life X Medical Center Corp | |
|
2055 Wood St Ste 104 Sarasota FL 34237-7928 | |
| (941) 330-1919 | |
| (941) 330-1949 |
| Full Name | Life X Medical Center Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 2055 Wood St Ste 104, Sarasota, Florida |
| Authorized Official Name and Position | Jose Alberto Munoz (PRESIDENT) |
| Authorized Official Contact | 7864484938 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life X Medical Center Corp 2055 Wood St Ste 104 Sarasota FL 34237-7928 Ph: (941) 330-1919 | Life X Medical Center Corp 2055 Wood St Ste 104 Sarasota FL 34237-7928 Ph: (941) 330-1919 |
| NPI Number | 1033723606 |
|---|---|
| Provider Enumeration Date | 09/01/2020 |
| Last Update Date | 05/23/2022 |
| Certification Date | 05/23/2022 |
| Medicare PECOS PAC ID | 9830507086 |
|---|---|
| Medicare Enrollment ID | O20210428000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033723606 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Joseph Walter King |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1255392890 PECOS PAC ID: 3678543444 Enrollment ID: I20141217002727 |
| Provider Name | Stephanie Stevens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043737745 PECOS PAC ID: 6507230109 Enrollment ID: I20230322001964 |
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