| Samara Home Doctor Services, Llc | |
|
1800 Pembrook Dr Ste 300 Orlando FL 32810-6378 | |
| (321) 200-4489 | |
| (407) 554-5860 |
| Full Name | Samara Home Doctor Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1800 Pembrook Dr Ste 300, Orlando, Florida |
| Authorized Official Name and Position | Judith Faustin (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3212004489 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samara Home Doctor Services, Llc 1800 Pembrook Dr Ste 300 Orlando FL 32810-6378 Ph: (321) 200-4489 | Samara Home Doctor Services, Llc 1800 Pembrook Dr Ste 300 Orlando FL 32810-6378 Ph: (321) 200-4489 |
| NPI Number | 1144704073 |
|---|---|
| Provider Enumeration Date | 09/17/2018 |
| Last Update Date | 06/04/2020 |
| Medicare PECOS PAC ID | 8325387095 |
|---|---|
| Medicare Enrollment ID | O20190225003205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144704073 | NPI | - | NPPES |
| LB425 | Other | FL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lori Pape |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487687497 PECOS PAC ID: 1052591195 Enrollment ID: I20110208000113 |
| Provider Name | Judith Faustin-gabriel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194137679 PECOS PAC ID: 3971801168 Enrollment ID: I20160421001371 |
| Provider Name | Roland Brutus |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1497754303 PECOS PAC ID: 2769482595 Enrollment ID: I20190426000536 |
| Provider Name | Nemie Thelot |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730673187 PECOS PAC ID: 6507295029 Enrollment ID: I20200405000147 |
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