| Lake Shore Specialty Group | |
|
368 Ne Franklin St Lake City FL 32055-3088 | |
| (386) 754-8000 | |
| (352) 733-0069 |
| Full Name | Lake Shore Specialty Group |
|---|---|
| Speciality | Clinic/center |
| Location | 368 Ne Franklin St, 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 |
|---|---|
| Lake Shore Specialty Group 720 Sw 2nd Ave Suite 360c Gainesville FL 32601-6271 Ph: (352) 733-0060 | Lake Shore Specialty Group 368 Ne Franklin St Lake City FL 32055-3088 Ph: (386) 754-8000 |
| NPI Number | 1730275538 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 05/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730275538 | NPI | - | NPPES |
| CK8077 | Other | FL | MEDICARE RR |
| 264258100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 4258 (Florida) | Primary |
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