| Jeffrey D Reynolds Llc | |
|
16627 Pablo Island Drive Groveland FL 34736-9238 | |
| (352) 777-9887 | |
| Not Available |
| Full Name | Jeffrey D Reynolds Llc |
|---|---|
| Speciality | Point of Service |
| Location | 16627 Pablo Island Drive, Groveland, Florida |
| Authorized Official Name and Position | Jeffrey D Reynolds (OWNER) |
| Authorized Official Contact | 3527779887 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey D Reynolds Llc 16627 Pablo Island Drive Groveland FL 34736-9238 Ph: (352) 777-9887 | Jeffrey D Reynolds Llc 16627 Pablo Island Drive Groveland FL 34736-9238 Ph: (352) 777-9887 |
| NPI Number | 1376320531 |
|---|---|
| Provider Enumeration Date | 09/12/2023 |
| Last Update Date | 09/12/2023 |
| Certification Date | 09/12/2023 |
| Medicare PECOS PAC ID | 1951756774 |
|---|---|
| Medicare Enrollment ID | O20231016000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376320531 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 305S00000X | Point Of Service | (* (Not Available)) | Primary |
| Provider Name | Jeffrey David Reynolds |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962565812 PECOS PAC ID: 2860847688 Enrollment ID: I20231016000627 |
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