| Lina L Feaster Pa | |
|
2460 Old Moultrie Rd Suite 1 St Augustine FL 32086-4197 | |
| (904) 794-2424 | |
| Not Available |
| Full Name | Lina L Feaster Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 2460 Old Moultrie Rd, St Augustine, Florida |
| Authorized Official Name and Position | Lina L Feaster (PRESIDENT MD) |
| Authorized Official Contact | 9047942424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lina L Feaster Pa Po Box 3463 St Augustine FL 32085-3463 Ph: (904) 794-2424 | Lina L Feaster Pa 2460 Old Moultrie Rd Suite 1 St Augustine FL 32086-4197 Ph: (904) 794-2424 |
| NPI Number | 1922205251 |
|---|---|
| Provider Enumeration Date | 06/29/2007 |
| Last Update Date | 11/20/2007 |
| Medicare PECOS PAC ID | 0345136255 |
|---|---|
| Medicare Enrollment ID | O20040226000842 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922205251 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | ME79232 (Florida) | Primary |
| Provider Name | Lina L Feaster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982631503 PECOS PAC ID: 8224924139 Enrollment ID: I20040226000884 |
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