Glory Center, P.a.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

GLORY CENTER, P.A.

Practice address

6641 Madison St
Suite 3
New Port Richey, FL 34652-1966

Phone

(727) 232-0826

Fax

(727) 597-8487

NPI assigned

Jul 31, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David O Ikudayisi, M.D.

Title

Owner/President

Phone

(813) 495-2234

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360022400000",
    "number": "1558617399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6641 MADISON ST",
            "address_2": "SUITE 3",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346521966",
            "telephone_number": "727-232-0826",
            "fax_number": "727-597-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6641 MADISON ST",
            "address_2": "SUITE 3",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346521966",
            "telephone_number": "727-232-0826",
            "fax_number": "727-597-8487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLORY CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-31",
        "last_updated": "2013-02-05",
        "status": "A",
        "authorized_official_last_name": "IKUDAYISI",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "813-495-2234",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Elizabeth Gleason II
• Christina Anne Glenn, MS, CCC-SLP
• Patricia Louise Glenn
• Teri Gail Glenn, LCSW, BCD
• John Thomas Glenny III, MSN, APRN, AGNP-C
• Kristine Glover, NP
• Jerry Gluck
• Devon Glynn, FNP-BC
• Kelly Goeden, LCSW
• Abigail Lynn Gogolski

• Clinic/Center in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.