| |
1850 S Byron Butler Pkwy Perry FL 32348 | |
(850) 838-2030 | |
(850) 838-2040 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1850 S Byron Butler Pkwy, Perry, Florida |
Authorized Official Name and Position | Lane Miller Lunn (PRESIDENT/CEO) |
Authorized Official Contact | 8503854494 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2804 Remington Green Cir Ste 2 Tallahassee FL 32308-1550 Ph: (850) 385-4494 | 1850 S Byron Butler Pkwy Perry FL 32348 Ph: (850) 838-2030 |
NPI Number | 1255526638 |
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Provider Enumeration Date | 09/10/2007 |
Last Update Date | 01/17/2022 |
Medicare PECOS PAC ID | 6103737697 |
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Medicare Enrollment ID | O20040102000848 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255526638 | NPI | - | NPPES |
692957500 | Medicaid | FL | |
692957501 | Medicaid | FL | |
99388 | Other | FL | MEDICARE PART B |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Patrick Brown |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1346466463 PECOS PAC ID: 9335211218 Enrollment ID: I20080709000655 |
Provider Name | Jeffrey David Wasserman |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1972507556 PECOS PAC ID: 6305977125 Enrollment ID: I20100623000312 |
Provider Name | Elaine Larkins |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780688341 PECOS PAC ID: 3577694694 Enrollment ID: I20100706000205 |
Provider Name | Bogdan Maliszewski |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1750385324 PECOS PAC ID: 2961300751 Enrollment ID: I20100901000770 |
Provider Name | Debbi Rye |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659741551 PECOS PAC ID: 1355641135 Enrollment ID: I20151201000269 |
Provider Name | Christian Hernandez Nazario |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1184877235 PECOS PAC ID: 6901940360 Enrollment ID: I20190725002982 |
Provider Name | Carla Janese Robertson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1891345567 PECOS PAC ID: 9931430782 Enrollment ID: I20191009003167 |
Provider Name | Shirley Blanco |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659913606 PECOS PAC ID: 0042642092 Enrollment ID: I20191113003100 |
Provider Name | Jennifer Vital Whitfield |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1396384582 PECOS PAC ID: 7810324720 Enrollment ID: I20200304002642 |
Provider Name | Rita Faye Thompson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1174643233 PECOS PAC ID: 3870922545 Enrollment ID: I20200331002699 |
Provider Name | Terri Beth Ellison |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073137816 PECOS PAC ID: 5991127219 Enrollment ID: I20200615002424 |
Provider Name | Alicia Davis Melvin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578177788 PECOS PAC ID: 5799197703 Enrollment ID: I20201216001939 |
Provider Name | Deliana Gonzalez Torres |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1316068703 PECOS PAC ID: 5294713061 Enrollment ID: I20210517000323 |
Provider Name | Jenifer Brickler |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1861999765 PECOS PAC ID: 3375969751 Enrollment ID: I20220922001349 |
Provider Name | Kelly L Dees |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1376269878 PECOS PAC ID: 5092182246 Enrollment ID: I20221101002833 |
Provider Name | Lorie Knight Barrow |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336843374 PECOS PAC ID: 2860867207 Enrollment ID: I20230417001708 |
Provider Name | Elizabeth Ann Mcdowell |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114159894 PECOS PAC ID: 8426409483 Enrollment ID: I20240104000987 |
Provider Name | Deshala Teshanne Frazier |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356886196 PECOS PAC ID: 8921541772 Enrollment ID: I20240620003487 |
Provider Name | Terri Lynn Roberts |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114797552 PECOS PAC ID: 4789128224 Enrollment ID: I20240626000761 |
Perry Chiropractic Clinic, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 305 N Orange St, Perry, FL 32347 Phone: 850-584-7117 Fax: 850-584-7119 | |