Provider Demographics
NPI:1770249534
Name:WEST FLORIDA MEDICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:WEST FLORIDA MEDICAL ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLACASTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-513-5906
Mailing Address - Street 1:PO BOX 640573
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-0573
Mailing Address - Country:US
Mailing Address - Phone:352-513-5906
Mailing Address - Fax:
Practice Address - Street 1:5559 E SR 44 UNIT 4
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-8282
Practice Address - Country:US
Practice Address - Phone:352-513-5906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health