| Columbia Family Medicine | |
|
238 Sw Cullen Ave Fort White FL 32038-3536 | |
| (386) 497-1397 | |
| Not Available |
| Full Name | Columbia Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 238 Sw Cullen Ave, Fort White, Florida |
| Authorized Official Name and Position | David Wayne Davis (OWNER) |
| Authorized Official Contact | 3863650809 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia Family Medicine 238 Sw Cullen Ave Fort White FL 32038-3536 Ph: (386) 365-0809 | Columbia Family Medicine 238 Sw Cullen Ave Fort White FL 32038-3536 Ph: (386) 497-1397 |
| NPI Number | 1104533173 |
|---|---|
| Provider Enumeration Date | 10/31/2022 |
| Last Update Date | 01/23/2023 |
| Medicare PECOS PAC ID | 0042689366 |
|---|---|
| Medicare Enrollment ID | O20221208001801 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104533173 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | David Wayne Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134609704 PECOS PAC ID: 1658615893 Enrollment ID: I20181129000921 |
Grace Pediatrics Pl Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 238 Sw Cullen Ave, Fort White, FL 32038 Phone: 386-243-8474 |