| Vaxonsite, Llc | |
|
1434 Jam Ln Odessa FL 33556-3704 | |
| (727) 489-4358 | |
| (813) 342-7934 |
| Full Name | Vaxonsite, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1434 Jam Ln, Odessa, Florida |
| Authorized Official Name and Position | Sean P Curtin (PRESIDENT/CFO) |
| Authorized Official Contact | 7274894358 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vaxonsite, Llc Po Box 1166 Odessa FL 33556-1051 Ph: (727) 489-4358 | Vaxonsite, Llc 1434 Jam Ln Odessa FL 33556-3704 Ph: (727) 489-4358 |
| NPI Number | 1982152054 |
|---|---|
| Provider Enumeration Date | 09/16/2016 |
| Last Update Date | 09/16/2016 |
| Medicare PECOS PAC ID | 7113295932 |
|---|---|
| Medicare Enrollment ID | O20170620003352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982152054 | NPI | - | NPPES |
| HCC10745 | Other | FL | AHCA - HEALTH CARE CLINIC LICENSE # HCC10745 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | HCC10745 (Florida) | Primary |
| Provider Name | Casey J O'donnell |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1922062157 PECOS PAC ID: 0840295200 Enrollment ID: I20120113000517 |
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