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MEDICAL PAVILION CLINC
NPI 1063671683
Preferred Provider Organization in Port Charlotte, FL

Active since June 09, 2008
2525 HARBOR BLVD, SUITE 102, PORT CHARLOTTE, FL 33952(941) 629-9190(941) 625-2751 Get Directions Write a Review

NPPES record last updated: June 9, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Medical Pavilion Clinc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEDICAL PAVILION CLINC (NPI 1063671683) is a healthcare organization registered as a preferred provider organization in Port Charlotte, Florida and active in the NPI registry since June 2008. The organization lists David S Ballestas, Doctor - Owner, as its authorized official.

NPPES Registry Identity

NPI1063671683
Entity TypeOrganization
Primary Taxonomy305R00000X
Legal Business NameMEDICAL PAVILION CLINC
Location Address2525 HARBOR BLVD, SUITE 102Port Charlotte, FL 33952-5317
Mailing Address2525 Harbor Blvd, Suite 102Port Charlotte, FL 33952-5317 · (941) 629-9190 · Fax (941) 625-2751
Phone(941) 629-9190
Fax(941) 625-2751
Organization SubpartNo
Authorized OfficialDavid S BallestasDoctor - Owner · (941) 629-9190
Enumeration DateJune 9, 2008
✔ NPI 1063671683 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPreferred Provider OrganizationManaged Care Organizations
Taxonomy Code305R00000X
License✔ Licensed in FL · ME0044391
Definition

A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.

2525 HARBOR BLVD, Port Charlotte, FL 33952
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Other Identifiers 1

Medicaid0608916500FL

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SAMANTHA JEAN M.D.
Family Medicine
2525 HARBOR BLVD, SUITE 308
PORT CHARLOTTE, FL 33952
Charlotte County (419) 629-7777
MICHAEL JAMES LAWSON ARNP
Nurse Practitioner
2525 HARBOR BLVD, SUITE 102
PORT CHARLOTTE, FL 33952
Charlotte County (941) 629-9190
LUIS GERARDO MARMOL M.D.
Otolaryngology
2525 HARBOR BLVD, SUITE # 303
PORT CHARLOTTE, FL 33952
Charlotte County (941) 235-1901
STEPHEN PETROFSKY DPM PA
Durable Medical Equipment & Medical Supplies
2525 HARBOR BLVD, SUITE 206
PT CHARLOTTE, FL 33952
Charlotte County (941) 625-3330
DAVID S BALLESTAS MD PA
Specialist
2525 HARBOR BLVD, SUITE 102
PORT CHARLOTTE, FL 33952
Charlotte County (941) 629-7593
DR. ANTONIO LABITAG GABARDA M.D.
Internal Medicine (Hematology & Oncology)
2525 HARBOR BLVD, SUITE 205
PORT CHARLOTTE, FL 33952
Charlotte County (941) 629-4660
DR. JEROME B COHEN MD
Internal Medicine
2525 HARBOR BLVD, 104
PORT CHARLOTTE, FL 33952
Charlotte County (941) 629-5757
JENS CHRISTIAN CARLSEN DO
Urology
2525 HARBOR BLVD, SUITE 201A
PORT CHARLOTTE, FL 33952
Charlotte County (941) 421-0756

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Medical Pavilion Clinc's NPI number?

The NPI number for Medical Pavilion Clinc is 1063671683. It was assigned to this organization in the NPPES registry on June 9, 2008.

Where is Medical Pavilion Clinc located?

Medical Pavilion Clinc is located at 2525 Harbor Blvd Suite 102, Port Charlotte, FL 33952. The listed phone number is (941) 629-9190.

What is Medical Pavilion Clinc's specialty?

The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.

When was this NPI record last updated?

The NPPES record for Medical Pavilion Clinc was last updated on June 9, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.