Provider Demographics
NPI:1437255650
Name:ZWEIBACH & CHAMPION, M.D.S, P.A.
Entity Type:Organization
Organization Name:ZWEIBACH & CHAMPION, M.D.S, P.A.
Other - Org Name:WOMENS HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZWEIBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-571-2777
Mailing Address - Street 1:815 S PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6063
Mailing Address - Country:US
Mailing Address - Phone:813-571-2777
Mailing Address - Fax:813-571-2888
Practice Address - Street 1:815 S PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6063
Practice Address - Country:US
Practice Address - Phone:813-571-2777
Practice Address - Fax:813-571-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL154572.0000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274786300Medicaid
FL274786300Medicaid