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4700 N Habana Ave Suite 300 Tampa FL 33614-7160 | |
| (813) 870-0392 | |
| (813) 871-6305 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 4700 N Habana Ave, Tampa, Florida |
| Authorized Official Name and Position | Gary Lee Wood (PRESIDENT OWNER) |
| Authorized Official Contact | 8138700392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4700 N Habana Ave Suite 300 Tampa FL 33614-7160 Ph: (813) 870-0392 | 4700 N Habana Ave Suite 300 Tampa FL 33614-7160 Ph: (813) 870-0392 |
| NPI Number | 1861420226 |
|---|---|
| Provider Enumeration Date | 06/28/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8022284363 |
|---|---|
| Medicare Enrollment ID | O20120109000158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861420226 | NPI | - | NPPES |
| 39977 | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Gary L Wood |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518912997 PECOS PAC ID: 5799814158 Enrollment ID: I20100522000021 |
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