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105 Main St Enterprise FL 32725-8138 | |
(407) 322-8645 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 105 Main St, Enterprise, Florida |
Authorized Official Name and Position | Janelle Alycee Dunn (CEO) |
Authorized Official Contact | 4073228645 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4930 E Lake Mary Blvd Sanford FL 32771-5003 Ph: (407) 322-8645 | 105 Main St Enterprise FL 32725-8138 Ph: (407) 322-8645 |
NPI Number | 1447935622 |
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Provider Enumeration Date | 06/16/2023 |
Last Update Date | 11/14/2024 |
Medicare PECOS PAC ID | 3870519234 |
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Medicare Enrollment ID | O20240802000526 |
Identifier | Type | State | Issuer |
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1447935622 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |