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1908 Center St Leesburg FL 34748-4812 | |
| (352) 253-4190 | |
| (352) 240-3944 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1908 Center St, Leesburg, Florida |
| Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | 1908 Center St Leesburg FL 34748-4812 Ph: (352) 253-4190 |
| NPI Number | 1700550902 |
|---|---|
| Provider Enumeration Date | 08/03/2021 |
| Last Update Date | 08/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700550902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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