| Meadowcrest Healthcare Services Llc | |
|
512 N Lecanto Hwy Lecanto FL 34461-8547 | |
| (352) 795-0644 | |
| (352) 795-5950 |
| Full Name | Meadowcrest Healthcare Services Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 512 N Lecanto Hwy, Lecanto, Florida |
| Authorized Official Name and Position | Ryan Dickert (OWNER) |
| Authorized Official Contact | 3527950644 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meadowcrest Healthcare Services Llc 1250 N Vantage Point Dr Crystal River FL 34429-5736 Ph: (352) 795-0644 | Meadowcrest Healthcare Services Llc 512 N Lecanto Hwy Lecanto FL 34461-8547 Ph: (352) 795-0644 |
| NPI Number | 1891541421 |
|---|---|
| Provider Enumeration Date | 04/25/2024 |
| Last Update Date | 04/25/2024 |
| Medicare PECOS PAC ID | 2163864018 |
|---|---|
| Medicare Enrollment ID | O20240523003454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891541421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Alex Jonathan Dickert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427342245 PECOS PAC ID: 6305094525 Enrollment ID: I20120913000238 |
| Provider Name | Ryan Spencer Dickert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306231212 PECOS PAC ID: 8628382983 Enrollment ID: I20161026001624 |
| Provider Name | Jessica L Fong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629859335 PECOS PAC ID: 4385091818 Enrollment ID: I20231106001453 |
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