Provider Demographics
NPI:1265722847
Name:DR ZOE SEGREE DC PA
Entity type:Organization
Organization Name:DR ZOE SEGREE DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-670-5494
Mailing Address - Street 1:661 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:EASTPOINT
Mailing Address - State:FL
Mailing Address - Zip Code:32328-3572
Mailing Address - Country:US
Mailing Address - Phone:850-670-5494
Mailing Address - Fax:850-670-1424
Practice Address - Street 1:661 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:EASTPOINT
Practice Address - State:FL
Practice Address - Zip Code:32328-3572
Practice Address - Country:US
Practice Address - Phone:850-670-5494
Practice Address - Fax:850-670-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6321261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381988400Medicaid
FL1558462606OtherNPI INDIVIDUAL
FLU51239Medicare UPIN
FL57032Medicare PIN