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3560 A1a S St Augustine FL 32080-9731 | |
| (904) 584-2273 | |
| (904) 429-9783 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 3560 A1a S, St Augustine, Florida |
| Authorized Official Name and Position | Dorothy Marie Aeppli (BILLING MANAGER) |
| Authorized Official Contact | 9045290141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3560 A1a S St Augustine FL 32080-9731 Ph: (904) 584-2273 | 3560 A1a S St Augustine FL 32080-9731 Ph: (904) 584-2273 |
| NPI Number | 1588091029 |
|---|---|
| Provider Enumeration Date | 09/30/2013 |
| Last Update Date | 12/31/2024 |
| Medicare PECOS PAC ID | 8820229537 |
|---|---|
| Medicare Enrollment ID | O20140321001680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588091029 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME117337 (Florida) | Primary |
| Provider Name | Scott R Michaels |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760514921 PECOS PAC ID: 5496989550 Enrollment ID: I20131004000176 |
| Provider Name | Emily D Benn |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1396119301 PECOS PAC ID: 2961783717 Enrollment ID: I20170110001401 |
| Provider Name | Kelli Mclaughlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750836086 PECOS PAC ID: 2365710969 Enrollment ID: I20170623001031 |
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