| |
21815 S.e .71st Avenue Hawthorne FL 32640-3974 | |
(352) 481-2400 | |
(352) 481-2777 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 21815 S.e .71st Avenue, Hawthorne, Florida |
Authorized Official Name and Position | Patricia O Mccullough (PRESIDENT/OWNER) |
Authorized Official Contact | 3524812400 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
21815 S.e .71st Avenue Hawthorne FL 32640-3974 Ph: (352) 481-2400 | 21815 S.e .71st Avenue Hawthorne FL 32640-3974 Ph: (352) 481-2400 |
NPI Number | 1023196318 |
---|---|
Provider Enumeration Date | 11/02/2006 |
Last Update Date | 07/06/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023196318 | NPI | - | NPPES |
37209S100 | Medicaid | FL | |
45696 | Other | FL | BLUE CROSS BLUE SHIELD |
18622 | Other | FL | BLUE CROSS BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | ME63062 (Florida) | Secondary |
207Q00000X | Family Medicine | HCC8421 (Florida) | Primary |
David M. Trax, D.c., P.a. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6005 Se Us Highway 301, Suite 405 A, Hawthorne, FL 32640 Phone: 352-481-9994 Fax: 352-481-9954 | |
Sorrid Medical Consultants Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 640 Lake Susan Rd, Hawthorne, FL 32640 Phone: 352-246-0936 |