| |
504 Ne Cholokka Blvd Micanopy FL 32667 | |
(352) 466-4600 | |
(352) 466-4617 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 504 Ne Cholokka Blvd, Micanopy, Florida |
Authorized Official Name and Position | Jon Hemstreet (PRESIDENT) |
Authorized Official Contact | 8283901317 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 730 Micanopy FL 32667-0730 Ph: () - | 504 Ne Cholokka Blvd Micanopy FL 32667 Ph: (352) 466-4600 |
NPI Number | 1114419769 |
---|---|
Provider Enumeration Date | 05/30/2018 |
Last Update Date | 10/19/2018 |
Medicare PECOS PAC ID | 1456604016 |
---|---|
Medicare Enrollment ID | O20181029000998 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114419769 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | ME86620 (Florida) | Primary |
Provider Name | Jon E Hemstreet |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1356318471 PECOS PAC ID: 9638269780 Enrollment ID: I20071213000412 |