| Ideal Medclinic Inc | |
|
6572 River Park Dr Ste 102 Riverdale GA 30274-2214 | |
| (770) 629-2296 | |
| Not Available |
| Full Name | Ideal Medclinic Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 6572 River Park Dr Ste 102, Riverdale, Georgia |
| Authorized Official Name and Position | Melissa Salcido (CFO) |
| Authorized Official Contact | 6783147235 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ideal Medclinic Inc 6572 River Park Dr Ste 102 Riverdale GA 30274-2214 Ph: (770) 629-2296 | Ideal Medclinic Inc 6572 River Park Dr Ste 102 Riverdale GA 30274-2214 Ph: (770) 629-2296 |
| NPI Number | 1841955937 |
|---|---|
| Provider Enumeration Date | 11/03/2021 |
| Last Update Date | 11/03/2021 |
| Medicare PECOS PAC ID | 9436541984 |
|---|---|
| Medicare Enrollment ID | O20220113002092 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841955937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Eloy Edilberto Diaz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063461051 PECOS PAC ID: 6507770260 Enrollment ID: I20101026000885 |
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