Provider Demographics
NPI:1790871424
Name:TOTAL SENIOR HEALTH CARE MOBILE PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:TOTAL SENIOR HEALTH CARE MOBILE PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DIPASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-390-2032
Mailing Address - Street 1:3368 WOODS EDGE CIR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-3437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3368 WOODS EDGE CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-3437
Practice Address - Country:US
Practice Address - Phone:239-390-2032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONALIZED PHYSICIAN CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty