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173 Nw Albritton Ln Lake City FL 32055-4451 | |
| (386) 755-4020 | |
| (386) 752-9143 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 173 Nw Albritton Ln, Lake City, Florida |
| Authorized Official Name and Position | Anita H. Rembert (C.E.O.) |
| Authorized Official Contact | 3864540698 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
23476 Nw 186th Ave High Springs FL 32643-0673 Ph: (386) 454-0698 | 173 Nw Albritton Ln Lake City FL 32055-4451 Ph: (386) 755-4020 |
| NPI Number | 1124442355 |
|---|---|
| Provider Enumeration Date | 02/07/2014 |
| Last Update Date | 01/10/2025 |
| Medicare PECOS PAC ID | 2365359387 |
|---|---|
| Medicare Enrollment ID | O20140311000709 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124442355 | NPI | - | NPPES |
| 97069 | Other | FL | BCBSFL |
| 029552300 | Medicaid | FL | |
| 101867 | Other | FL | MEDICARE NGS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (Florida) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Gregory N Borganelli Dmd Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 875 Sw State Rd 47, Lake City, FL 32025 Phone: 386-752-8200 Fax: 386-752-8209 | |
Melanie Holden, Dmd, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 255 Sw Main Blvd, Lake City, FL 32025 Phone: 386-752-2480 | |
David F Randolph Dmd Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1779 Sw Barnett Way Ste 101, Lake City, FL 32025 Phone: 386-755-4033 Fax: 386-755-2581 |