Provider Demographics
NPI:1356656813
Name:ABSOLUTE MEDICAL SERVICES, PA
Entity Type:Organization
Organization Name:ABSOLUTE MEDICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACCHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-854-5530
Mailing Address - Street 1:521 SE FORT ISLAND TRAIL, SUITE E
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-8904
Mailing Address - Country:US
Mailing Address - Phone:352-563-5858
Mailing Address - Fax:
Practice Address - Street 1:521 SE FORT ISLAND TRL
Practice Address - Street 2:SUITE E
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8904
Practice Address - Country:US
Practice Address - Phone:352-563-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82470Medicare PIN
FLD27368Medicare UPIN