| Advance Medical Specialty Llc | |
|
8550 Ne 138th Ln Ste 500 Lady Lake FL 32159-6804 | |
| (352) 633-9858 | |
| (352) 633-9870 |
| Full Name | Advance Medical Specialty Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8550 Ne 138th Ln Ste 500, Lady Lake, Florida |
| Authorized Official Name and Position | Hemwattie S Jaimangal (PRESIDENT) |
| Authorized Official Contact | 3526339858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advance Medical Specialty Llc 18981 Us Highway 441 Ste 121 Mount Dora FL 32757-6735 Ph: (352) 201-5949 | Advance Medical Specialty Llc 8550 Ne 138th Ln Ste 500 Lady Lake FL 32159-6804 Ph: (352) 633-9858 |
| NPI Number | 1114449345 |
|---|---|
| Provider Enumeration Date | 07/10/2017 |
| Last Update Date | 06/05/2024 |
| Medicare PECOS PAC ID | 0042582470 |
|---|---|
| Medicare Enrollment ID | O20170821001170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114449345 | NPI | - | NPPES |
| 021679600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | OS10278 (Florida) | Primary |
| Provider Name | Hemwattie S Jaimangal |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1821019001 PECOS PAC ID: 8820173750 Enrollment ID: I20081027000470 |
| Provider Name | Diane Ruth Kuehnlenz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649224585 PECOS PAC ID: 8224032453 Enrollment ID: I20190621001698 |
| Provider Name | Kelly Diaz-vazquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972380590 PECOS PAC ID: 5395191498 Enrollment ID: I20231025003783 |
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