| |
601 Howard St E Live Oak FL 32064-3401 | |
(786) 873-7045 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 601 Howard St E, Live Oak, Florida |
Authorized Official Name and Position | Giraldo Olivera (CEO) |
Authorized Official Contact | 3863206900 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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601 Howard St E Live Oak FL 32064-3401 Ph: (786) 873-7045 | 601 Howard St E Live Oak FL 32064-3401 Ph: (786) 873-7045 |
NPI Number | 1275399289 |
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Provider Enumeration Date | 02/27/2024 |
Last Update Date | 01/23/2025 |
Medicare PECOS PAC ID | 7618402009 |
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Medicare Enrollment ID | O20241121003331 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275399289 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Giraldo Olivera |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508488503 PECOS PAC ID: 2961817648 Enrollment ID: I20210210000227 |
Acv Community Services Ll Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10820 Marvin E Jones Blvd, Live Oak, FL 32060 Phone: 386-658-5341 | |
Horizon Pediatrics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 611 Demorest St Se, Live Oak, FL 32064 Phone: 386-362-5437 Fax: 386-362-5440 | |