| St. Mary's Neurology Center, Inc. | |
|
15267 Amberly Dr Tampa FL 33647-2155 | |
| (813) 972-5414 | |
| (813) 972-5413 |
| Full Name | St. Mary's Neurology Center, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 15267 Amberly Dr, Tampa, Florida |
| Authorized Official Name and Position | Reena J. Kavilaveettil (PRESIDENT) |
| Authorized Official Contact | 8139725414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Mary's Neurology Center, Inc. 15267 Amberly Dr Tampa FL 33647-2155 Ph: (813) 972-5414 | St. Mary's Neurology Center, Inc. 15267 Amberly Dr Tampa FL 33647-2155 Ph: (813) 972-5414 |
| NPI Number | 1477641959 |
|---|---|
| Provider Enumeration Date | 10/10/2006 |
| Last Update Date | 07/02/2015 |
| Medicare PECOS PAC ID | 7618975517 |
|---|---|
| Medicare Enrollment ID | O20061130000329 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477641959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | ME92765 (Florida) | Primary |
| Provider Name | Reena J Kavilaveettil |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629023379 PECOS PAC ID: 5890725709 Enrollment ID: I20050819000171 |
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