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201 West Lattin Street Hastings FL 32145 | |
(904) 824-8158 | |
(904) 823-1284 |
Full Name | |
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Speciality | Family Medicine |
Location | 201 West Lattin Street, Hastings, Florida |
Authorized Official Name and Position | Shriram S Marathe (PRESIDENT) |
Authorized Official Contact | 9048248158 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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665 State Road 207 Suite 102 Saint Augustine FL 32084-5938 Ph: (904) 824-8158 | 201 West Lattin Street Hastings FL 32145 Ph: (904) 824-8158 |
NPI Number | 1265592745 |
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Provider Enumeration Date | 12/12/2006 |
Last Update Date | 06/19/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265592745 | NPI | - | NPPES |
250270403 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 94907 (Florida) | Primary |
207RP1001X | Internal Medicine - Pulmonary Disease | 91451 (Florida) | Secondary |