| Dr Eilis Clark Md | |
|
210 S Salisbury Ter Lecanto FL 34461-5104 | |
| (352) 631-7460 | |
| Not Available |
| Full Name | Dr Eilis Clark Md |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 210 S Salisbury Ter, Lecanto, Florida |
| Authorized Official Name and Position | Eilis Clark (MGRM) |
| Authorized Official Contact | 3526317460 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Eilis Clark Md 210 S Salisbury Ter Lecanto FL 34461-5104 Ph: () - | Dr Eilis Clark Md 210 S Salisbury Ter Lecanto FL 34461-5104 Ph: (352) 631-7460 |
| NPI Number | 1174185276 |
|---|---|
| Provider Enumeration Date | 06/28/2019 |
| Last Update Date | 01/04/2020 |
| Medicare PECOS PAC ID | 9739417908 |
|---|---|
| Medicare Enrollment ID | O20190826002942 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174185276 | NPI | - | NPPES |
| 011682400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Eilis Kisis Clark |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073621215 PECOS PAC ID: 7315170651 Enrollment ID: I20181107000200 |
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Pediatric And Internal Medicine Specialists, Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1990 N Prospect Ave, Lecanto, FL 34461 Phone: 352-527-6888 Fax: 352-527-8818 | |
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