Provider Demographics
NPI:1619215316
Name:BODE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BODE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:YENIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:813-900-5690
Mailing Address - Street 1:231 ROYAL PALM WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-9425
Mailing Address - Country:US
Mailing Address - Phone:813-900-5690
Mailing Address - Fax:352-600-9234
Practice Address - Street 1:12144 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5575
Practice Address - Country:US
Practice Address - Phone:813-900-5690
Practice Address - Fax:352-600-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10528261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service