Basic Information
| Provider Information | |||||||||
| NPI: | 1861769671 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DYNAMIC HEALTH CARE SERVICES,LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DYNAMIC HEALTH CARE SERVICES, PA | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346986615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277344000 | ||||||||
| FaxNumber: | 7277244110 | ||||||||
| Practice Location | |||||||||
| Address1: | 703 VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346986615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277344000 | ||||||||
| FaxNumber: | 7277244110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2011 | ||||||||
| LastUpdateDate: | 07/01/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7277344000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 002VD | 01 | FL | BCBS | OTHER | 004449500 | 05 | FL | MEDICAID |