| Outreach Community Care Network, Inc. | |
|
240 N Frederick Ave Suite D Daytona Beach FL 32114-3400 | |
| (386) 255-5569 | |
| (386) 257-1245 |
| Full Name | Outreach Community Care Network, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 240 N Frederick Ave, Daytona Beach, Florida |
| Authorized Official Name and Position | Loretta Jennings (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3862555569 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Outreach Community Care Network, Inc. 240 N Frederick Ave Suite D Daytona Beach FL 32114-3400 Ph: (386) 255-5569 | Outreach Community Care Network, Inc. 240 N Frederick Ave Suite D Daytona Beach FL 32114-3400 Ph: (386) 255-5569 |
| NPI Number | 1952738049 |
|---|---|
| Provider Enumeration Date | 10/03/2013 |
| Last Update Date | 02/20/2014 |
| Medicare PECOS PAC ID | 9133350010 |
|---|---|
| Medicare Enrollment ID | O20140317001720 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952738049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 12473 (Florida) | Primary |
| Provider Name | Winston E Lightburn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598791964 PECOS PAC ID: 0244262871 Enrollment ID: I20050906000115 |
| Provider Name | Blanca C Luna |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891730974 PECOS PAC ID: 2062571946 Enrollment ID: I20081106000662 |
| Provider Name | Ronald S Rusiecki |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1487859955 PECOS PAC ID: 5092851337 Enrollment ID: I20090930000262 |
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