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4090 S Ridgewood Ave Port Orange FL 32127-4501 | |
| (386) 761-0050 | |
| (386) 761-1167 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 4090 S Ridgewood Ave, Port Orange, Florida |
| Authorized Official Name and Position | Kevin Meriwether (DIVISION PRESIDENT) |
| Authorized Official Contact | 3055002000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (305) 500-2000 | 4090 S Ridgewood Ave Port Orange FL 32127-4501 Ph: (386) 761-0050 |
| NPI Number | 1619433869 |
|---|---|
| Provider Enumeration Date | 02/13/2019 |
| Last Update Date | 06/21/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619433869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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