Basic Information
| Provider Information | |||||||||
| NPI: | 1750642278 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | E&C HEALTH SERVICES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3451 E LOUISE LN | ||||||||
| Address2: | SUITE 124 | ||||||||
| City: | HERNANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344424396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7276417485 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3451 E LOUISE LN | ||||||||
| Address2: | SUITE 124 | ||||||||
| City: | HERNANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344424396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7276417485 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2012 | ||||||||
| LastUpdateDate: | 05/31/2012 | ||||||||
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| AuthorizedOfficialLastName: | CHAVEZ | ||||||||
| AuthorizedOfficialFirstName: | CLAUDIA | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7276417485 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WP0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 620979300 | 05 | FL | MEDICAID |