| Nature Coast Medical Group Pa | |
|
130 Sw 7th St Williston FL 32696-2404 | |
| (352) 528-5801 | |
| (352) 528-6019 |
| Full Name | Nature Coast Medical Group Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 130 Sw 7th St, Williston, Florida |
| Authorized Official Name and Position | Donald L Mccoy (PRESIDENT) |
| Authorized Official Contact | 3525285801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nature Coast Medical Group Pa 130 Sw 7th St Williston FL 32696-2404 Ph: (352) 528-5801 | Nature Coast Medical Group Pa 130 Sw 7th St Williston FL 32696-2404 Ph: (352) 528-5801 |
| NPI Number | 1275683682 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 07/02/2014 |
| Medicare PECOS PAC ID | 3173419488 |
|---|---|
| Medicare Enrollment ID | O20040225000003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275683682 | NPI | - | NPPES |
| 043550300 | Medicaid | FL | |
| 68-3803 | Other | FL | MEDICARE RURAL HEALTH CLINIC |
| 049437203 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0011887 (Florida) | Primary |
| 207R00000X | Internal Medicine | OS0005395 (Florida) | Secondary |
| Provider Name | Gregory L Stamper |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790765592 PECOS PAC ID: 1850372889 Enrollment ID: I20040526000794 |
| Provider Name | Donald L Mccoy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1740260033 PECOS PAC ID: 3274429444 Enrollment ID: I20040526001356 |
| Provider Name | Angela M Land |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326431438 PECOS PAC ID: 7315268331 Enrollment ID: I20150603000382 |
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