| Mid-florida Medical Group Pa | |
|
910 Old Camp Rd Bldg 150 Suite 154 Lady Lake FL 32162-5603 | |
| (352) 751-5055 | |
| (352) 751-5056 |
| Full Name | Mid-florida Medical Group Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 910 Old Camp Rd Bldg 150, Lady Lake, Florida |
| Authorized Official Name and Position | Thumati Gurappa Jagalur (PRESIDENT) |
| Authorized Official Contact | 3527515055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid-florida Medical Group Pa Po Box 218 Ocala FL 34478-0218 Ph: (352) 751-5055 | Mid-florida Medical Group Pa 910 Old Camp Rd Bldg 150 Suite 154 Lady Lake FL 32162-5603 Ph: (352) 751-5055 |
| NPI Number | 1588727168 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 03/21/2008 |
| Medicare PECOS PAC ID | 2163310673 |
|---|---|
| Medicare Enrollment ID | O20040308000173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588727168 | NPI | - | NPPES |
| 31587 | Other | FL | BCBS |
| DA7068 | Other | FL | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Thumati G Jagalur |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245276096 PECOS PAC ID: 1153219662 Enrollment ID: I20040309001301 |
| Provider Name | Sheryl L O'connell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639685944 PECOS PAC ID: 8123374014 Enrollment ID: I20180706002152 |
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