Provider Demographics
NPI:1265515001
Name:WEST FLORIDA MEDICAL ASSOCIATES P A
Entity type:Organization
Organization Name:WEST FLORIDA MEDICAL ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANANDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-746-1558
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:352-746-1558
Mailing Address - Fax:352-746-3838
Practice Address - Street 1:3404 C N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465
Practice Address - Country:US
Practice Address - Phone:352-746-1558
Practice Address - Fax:352-746-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800008970291U00000X
FL163W00000X, 207Q00000X, 208000000X, 2085R0202X, 208D00000X, 363A00000X, 363L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252639501Medicaid
FLCB6327OtherRAILROAD MEDICARE
FLCN2848OtherRAILROAD MEDICARE
FL252639500Medicaid
FLCG8031OtherRAILROAD MEDICARE
FL252639500Medicaid
FL21310Medicare PIN
FLCN2848OtherRAILROAD MEDICARE
FL21310CMedicare PIN
FL252639501Medicaid