Provider Demographics
NPI:1023238284
Name:MCBATH MEDICAL CENTER PA
Entity type:Organization
Organization Name:MCBATH MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:MCBATH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-567-6763
Mailing Address - Street 1:13933 17TH ST
Mailing Address - Street 2:STE: 101
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-4603
Mailing Address - Country:US
Mailing Address - Phone:352-567-6763
Mailing Address - Fax:352-567-1358
Practice Address - Street 1:13933 17TH ST
Practice Address - Street 2:STE: 101
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4603
Practice Address - Country:US
Practice Address - Phone:352-567-6763
Practice Address - Fax:352-567-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFC1011371207Q00000X
FLOS6111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278099200Medicaid
FL34296OtherBCBS
FLK3032Medicare PIN