OrganizationDavid S Ballestas Md Pa(Medical Pavilion Clinic)SpecialistOther Service ProvidersPractice Address2525 Harbor Blvd, Suite 102, Port Charlotte, FL 33952-5317(941) 629-7593PECOS EnrollmentBased on the most recent information from CMS, provider David S Ballestas Md Pa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 1:10 PM.Profile DetailsProvider ID1093901282Provider TypeOrganizationFull NameDavid S Ballestas Md PaOther NameMedical Pavilion ClinicSubpartNoEnumeration Date9/20/2007Last Updated5/9/2008Contact InformationPractice LocationPractice Address2525 Harbor Blvd, Suite 102, Port Charlotte, FL 33952-5317Phone(941) 629-7593Fax(941) 625-2751Mailing LocationMailing Address2525 Harbor Blvd, Suite 102, Port Charlotte, FL 33952-5317Phone(941) 629-7593Fax(941) 625-2751Authorized OfficialNameBallestas, David S. (Owner/President)Phone(941) 629-7593Provider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicenseH87694FloridaProvider IdentifiersIDDescriptionIssuerID40389DescriptionOtherIssuerMEDICARE GROUP NUMBERFlorida