Olympia Medical Group, Llc | |
2306 North Blvd W Ste C Davenport FL 33837-8976 | |
(863) 547-9200 | |
Not Available |
Full Name | Olympia Medical Group, Llc |
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Speciality | Family Medicine |
Location | 2306 North Blvd W Ste C, Davenport, Florida |
Authorized Official Name and Position | Bala Kode (MANAGING PARTNER) |
Authorized Official Contact | 8635479200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Olympia Medical Group, Llc 2306 North Blvd W Ste C Davenport FL 33837-8976 Ph: () - | Olympia Medical Group, Llc 2306 North Blvd W Ste C Davenport FL 33837-8976 Ph: (863) 547-9200 |
NPI Number | 1013473495 |
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Provider Enumeration Date | 02/11/2019 |
Last Update Date | 12/22/2023 |
Medicare PECOS PAC ID | 9830525880 |
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Medicare Enrollment ID | O20200211000563 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013473495 | NPI | - | NPPES |
105446600 | Medicaid | FL | |
HCC11921 | Other | FL | CLINIC LICENSE |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Nelson A Nieves |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1841327236 PECOS PAC ID: 5395808190 Enrollment ID: I20090105000516 |
Provider Name | Luis Miguel Nunez Arroyo |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1205307188 PECOS PAC ID: 2264867258 Enrollment ID: I20200623001690 |
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