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348 Ne Methodist Ter Suite 101 Lake City FL 32055-3409 | |
| (386) 755-4007 | |
| (352) 733-0069 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 348 Ne Methodist Ter, Lake City, Florida |
| Authorized Official Name and Position | Jodi Mansfield (SR. VICE PRESIDENT & COO) |
| Authorized Official Contact | 3522650440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
720 Sw 2nd Ave Suite 360c Gainesville FL 32601-6271 Ph: (352) 733-0060 | 348 Ne Methodist Ter Suite 101 Lake City FL 32055-3409 Ph: (386) 755-4007 |
| NPI Number | 1497854186 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 05/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497854186 | NPI | - | NPPES |
| 264258102 | Medicaid | FL | |
| CK8077 | Other | FL | MEDICARE RR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
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