A and R Psychiatric and Mental Health Services, LLC
Organization Active NPI Psychiatry Physician · Tampa, FL
NPI 1306114301 · NPPES record last updated Dec 5, 2011
Key facts
- NPI
- 1306114301
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- A AND R PSYCHIATRIC AND MENTAL HEALTH SERVICES, LLC
- Practice address
- 2150 W Dr Martin Luther King Jr Blvd
2ND Floor Suite B
Tampa, FL 33607-6551 - Phone
- (813) 872-1525
- Fax
- (813) 877-5910
- NPI assigned
- Dec 5, 2011
- Organization subpart
- No
Authorized official
- Name
- Mr. Justin M Roth, LCSW
- Title
- Owner
- Phone
- (813) 872-1525
Practitioners 2
-
Jennifer Roth, LCSW
-
Justin Michael Roth, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120208000441 | FL | Part B Supplier - Clinic/Group Practice | 0547427239 |
Receives reassigned benefits from 2 practitioners Practice locations: Tampa, FL |
National Provider Directory
Locations
2150 W Mlk Blvd
Ste B
Tampa, FL 33607
Phone (813) 872-1505
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | |||
| Psychiatry Physician |
2084P0800X | Yes |
Addresses
Primary practice location
2150 W Dr Martin Luther King Jr Blvd
2ND Floor Suite B
Tampa, FL 33607-6551
Mailing address
2150 W Dr Martin Luther King Jr Blvd
2ND Floor Suite B
Tampa, FL 33607-6551
Phone (813) 872-1525
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.