Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 261QM1300X | Clinic/Center | Multi-Specialty | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 61101 | OTHER | | HUMANA, INC |
| 2 | MC010 | MEDICAID | FLORIDA | |
| 3 | 14163 | OTHER | | WELLCARE FLORIDA |
| 4 | 39026 | OTHER | | UMR |
| 5 | 59274 | OTHER | | AVEMED HEALTH PLAN |
| 6 | 62308 | OTHER | | CIGNA |
| 7 | 64157 | OTHER | | MERITAIN HEALTH |
| 8 | 13551 | OTHER | | GHI/EMBLEM HEALTH PLAN |
| 9 | 28804 | OTHER | | AMERIGROUP |
| 10 | 68069 | OTHER | | SUNSHINE MEDICAID |
| 11 | WELLM2 | OTHER | | WELLMED/UNITED HEALTH CARE |
| 12 | 25133 | OTHER | | COVENTRY HEALTH CARE |
| 13 | 37602 | OTHER | | GOLDEN RULE INSURANCE PLAN |
| 14 | 36273 | OTHER | | AARP- UHC OVATIONS INSURANCE SOLUTIONS |
| 15 | 80214 | OTHER | | CHAMPVA |
| 16 | BS022 | OTHER | | BLUE SHIELD FLORIDA |
| 17 | 20133 | OTHER | | OPTIMUM INSURANCE PLAN |
| 18 | 41212 | OTHER | | FREEDOM HEALTH INSURANCE PLAN |
| 19 | 44054 | OTHER | | GEHA |
| 20 | 75261 | OTHER | | TPA |
| 21 | 87726 | OTHER | | UNITED HEALTH CARE |
| 22 | 06111 | OTHER | | OXFORD HEALTH PLAN |
| 23 | 27094 | OTHER | | SIMPLY HEALTH CARE/ CLEAR HEALTH ALLIANCE |
| 24 | 95019 | OTHER | | HEALTH FIRST HEALTH PLANS |
| 25 | 77003 | OTHER | | PRESTIGE |
| 26 | 14163 | OTHER | | STAYWELL HEALTH PLAN |
| 27 | 60054 | OTHER | | AETNA MEDICARE |
| 28 | 60054 | OTHER | | AETNA |
| 29 | 62308 | OTHER | | GREAT WEST PPO |
