Provider Demographics
NPI:1265601595
Name:CENTER FOR FAMILY HEALTH WELLNESS AND PREVENTION P A
Entity type:Organization
Organization Name:CENTER FOR FAMILY HEALTH WELLNESS AND PREVENTION P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:424-784-8829
Mailing Address - Street 1:3165 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE C1
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2032
Mailing Address - Country:US
Mailing Address - Phone:727-784-8829
Mailing Address - Fax:727-784-7718
Practice Address - Street 1:3165 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE C1
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2032
Practice Address - Country:US
Practice Address - Phone:727-784-8829
Practice Address - Fax:727-784-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2900304OtherAETNA
FL80189941OtherMEDICARE RAIL ROAD
FLK3819Medicare UPIN