Cross Creek Medical Pa | |
1381 Cross Creek Cir Suite A Tallahassee FL 32301-3723 | |
(850) 877-6393 | |
(850) 877-6393 |
Full Name | Cross Creek Medical Pa |
---|---|
Speciality | Internal Medicine |
Location | 1381 Cross Creek Cir, Tallahassee, Florida |
Authorized Official Name and Position | Wayne A Sampson (MEDICAL DIRECTOR) |
Authorized Official Contact | 8508776393 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Cross Creek Medical Pa 1381a Cross Creek Cir Tallahassee FL 32301-3729 Ph: (850) 877-6393 | Cross Creek Medical Pa 1381 Cross Creek Cir Suite A Tallahassee FL 32301-3723 Ph: (850) 877-6393 |
NPI Number | 1447438486 |
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Provider Enumeration Date | 02/01/2008 |
Last Update Date | 10/05/2011 |
Medicare PECOS PAC ID | 9436322641 |
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Medicare Enrollment ID | O20231101001251 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447438486 | NPI | - | NPPES |
250984900 | Medicaid | FL | |
DF9814 | Other | FL | RAILROAD MEDICARE |
003457000 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 0071014FLME (Florida) | Primary |
Provider Name | Wayne Sampson |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1306897582 PECOS PAC ID: 2163695388 Enrollment ID: I20111103000882 |
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