| Brent Hayden, M.d.,p.a. | |
|
733 Sw State Road 47 Lake City FL 32025-0453 | |
| (386) 755-0645 | |
| (386) 961-9541 |
| Full Name | Brent Hayden, M.d.,p.a. |
|---|---|
| Speciality | General Practice |
| Location | 733 Sw State Road 47, Lake City, Florida |
| Authorized Official Name and Position | Donald Brent Hayden (PRESIDENT) |
| Authorized Official Contact | 3867550645 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brent Hayden, M.d.,p.a. 733 Sw State Road 47 Lake City FL 32025-0453 Ph: (386) 755-0645 | Brent Hayden, M.d.,p.a. 733 Sw State Road 47 Lake City FL 32025-0453 Ph: (386) 755-0645 |
| NPI Number | 1326373606 |
|---|---|
| Provider Enumeration Date | 10/05/2009 |
| Last Update Date | 12/18/2012 |
| Medicare PECOS PAC ID | 7416093141 |
|---|---|
| Medicare Enrollment ID | O20091008000702 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326373606 | NPI | - | NPPES |
| ME0043394 | Other | FL | STATE LICENCE NUMBER |
| 12066 | Other | FL | MEDICARE ID-TYPE UNSPECIFIED |
| 041891900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Donald Brent Hayden |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1013061456 PECOS PAC ID: 2062558042 Enrollment ID: I20091005000581 |
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