Provider Demographics
NPI:1205438967
Name:CAMILLIAN MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:CAMILLIAN MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENCARNACION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-736-7733
Mailing Address - Street 1:2128 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5604
Mailing Address - Country:US
Mailing Address - Phone:727-736-7733
Mailing Address - Fax:
Practice Address - Street 1:2128 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5604
Practice Address - Country:US
Practice Address - Phone:727-736-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty