Farghaly Medical, Pllc | |
100 Whetstone Pl Suite 208 St Augustine FL 32086-5774 | |
(904) 826-7932 | |
(904) 819-6700 |
Full Name | Farghaly Medical, Pllc |
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Speciality | Family Medicine |
Location | 100 Whetstone Pl, St Augustine, Florida |
Authorized Official Name and Position | Rebecca Burnside (OFFICE MANAGER) |
Authorized Official Contact | 9048267932 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Farghaly Medical, Pllc 100 Whetstone Pl Suite 208 St Augustine FL 32086-5774 Ph: (904) 826-7932 | Farghaly Medical, Pllc 100 Whetstone Pl Suite 208 St Augustine FL 32086-5774 Ph: (904) 826-7932 |
NPI Number | 1114323631 |
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Provider Enumeration Date | 11/11/2014 |
Last Update Date | 11/11/2014 |
Medicare PECOS PAC ID | 0840515870 |
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Medicare Enrollment ID | O20150213000701 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114323631 | NPI | - | NPPES |
PENDING | Other | FL | PENDING |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | ME97900 (Florida) | Primary |
Provider Name | Basant Farghaly |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1104945872 PECOS PAC ID: 8921190315 Enrollment ID: I20070815000102 |
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