| Merlox Haven Llc | |
|
1653 Regal Oak Dr Kissimmee FL 34744-6644 | |
| (407) 334-6169 | |
| (407) 350-4613 |
| Full Name | Merlox Haven Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1653 Regal Oak Dr, Kissimmee, Florida |
| Authorized Official Name and Position | Merita Thomas Mason (ADMINISTRATOR) |
| Authorized Official Contact | 7183443828 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Merlox Haven Llc 3151 Granada Blvd Kissimmee FL 34746-3699 Ph: (407) 201-4012 | Merlox Haven Llc 1653 Regal Oak Dr Kissimmee FL 34744-6644 Ph: (407) 334-6169 |
| NPI Number | 1962811760 |
|---|---|
| Provider Enumeration Date | 08/05/2014 |
| Last Update Date | 11/07/2019 |
| Medicare PECOS PAC ID | 9234563164 |
|---|---|
| Medicare Enrollment ID | O20191230001849 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962811760 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 310400000X | Assisted Living Facility | AL12291 (Florida) | Secondary |
| Provider Name | Christopher A Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790064863 PECOS PAC ID: 5799915617 Enrollment ID: I20140220000471 |
| Provider Name | Merita Thomas Mason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508104563 PECOS PAC ID: 2668736992 Enrollment ID: I20180514000924 |
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