| Northeast Florida Psychiatric Association, Inc | |
|
790 Dunlawton Ave Suite J Port Orange FL 32127-4222 | |
| (386) 767-8584 | |
| (386) 767-8536 |
| Full Name | Northeast Florida Psychiatric Association, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 790 Dunlawton Ave, Port Orange, Florida |
| Authorized Official Name and Position | Gary W Frick (PROVIDER) |
| Authorized Official Contact | 3867678584 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Florida Psychiatric Association, Inc 790 Dunlawton Ave. Suite J Port Orange FL 32127-4222 Ph: (386) 767-8584 | Northeast Florida Psychiatric Association, Inc 790 Dunlawton Ave Suite J Port Orange FL 32127-4222 Ph: (386) 767-8584 |
| NPI Number | 1558798405 |
|---|---|
| Provider Enumeration Date | 10/07/2013 |
| Last Update Date | 04/10/2014 |
| Medicare PECOS PAC ID | 2860626876 |
|---|---|
| Medicare Enrollment ID | O20140204000771 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558798405 | NPI | - | NPPES |
| 2526671-00 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME73316 (Florida) | Primary |
| Provider Name | Gary W Frick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962548552 PECOS PAC ID: 7618861337 Enrollment ID: I20040212000092 |
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