| Dmh Family Medicine | |
|
113 E Main St Mayo FL 32066-4808 | |
| (386) 294-2475 | |
| (386) 294-2478 |
| Full Name | Dmh Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 113 E Main St, Mayo, Florida |
| Authorized Official Name and Position | Karen Tidwell (CLINIC MANAGER) |
| Authorized Official Contact | 8502235409 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dmh Family Medicine 117 Sw Virginia Cir Mayo FL 32066-4065 Ph: (386) 294-2475 | Dmh Family Medicine 113 E Main St Mayo FL 32066-4808 Ph: (386) 294-2475 |
| NPI Number | 1487613121 |
|---|---|
| Provider Enumeration Date | 03/21/2006 |
| Last Update Date | 11/27/2012 |
| Medicare PECOS PAC ID | 5092614503 |
|---|---|
| Medicare Enrollment ID | O20060210000200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487613121 | NPI | - | NPPES |
| 24274C | Other | BCBS | |
| 660123500 | Medicaid | FL | |
| 10D0961929 | Other | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 660123500 (Florida) | Primary |
River Valley Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 710 W Main St, Mayo, FL 32066 Phone: 386-294-1446 Fax: 386-294-4218 |