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1680 Sw Saint Lucie West Blvd Ste 204 Port St Lucie FL 34986-1927 | |
| (772) 212-1111 | |
| (772) 212-0201 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1680 Sw Saint Lucie West Blvd Ste 204, Port St Lucie, Florida |
| Authorized Official Name and Position | Timothy M Kennedy (OWNER) |
| Authorized Official Contact | 7722121111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
318 Se Fisk Rd Port St Lucie FL 34984-8920 Ph: (860) 883-5850 | 1680 Sw Saint Lucie West Blvd Ste 204 Port St Lucie FL 34986-1927 Ph: (772) 212-1111 |
| NPI Number | 1073962114 |
|---|---|
| Provider Enumeration Date | 06/09/2016 |
| Last Update Date | 02/12/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073962114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | CH11346 (Florida) | Primary |
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Wellmed Medical Management Of Florida Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 549 Nw Lake Whitney Place, Bldg I, Suite 101, Port St Lucie, FL 34986 Phone: 210-617-4706 | |
Independent Medical Group, Llc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7436 S Federal Hwy, Port St Lucie, FL 34952 Phone: 800-773-7066 | |
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