Full Name | |
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Speciality | Internal Medicine |
Location | 315 E Ash St, Perry, Florida |
Authorized Official Name and Position | Khalil M Afsh (OWNER) |
Authorized Official Contact | 8505843278 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
315 E Ash St Perry FL 32347-2029 Ph: (850) 584-3278 | 315 E Ash St Perry FL 32347-2029 Ph: (850) 584-3278 |
NPI Number | 1518926799 |
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Provider Enumeration Date | 03/17/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 9436116522 |
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Medicare Enrollment ID | O20041209001018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518926799 | NPI | - | NPPES |
CB3685 | Other | FL | RAILROAD MCR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Abdul H Sofi |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1205885613 PECOS PAC ID: 0749287977 Enrollment ID: I20061101000479 |
Provider Name | Diane Dodgen |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1134117385 PECOS PAC ID: 8426962176 Enrollment ID: I20071121000031 |
Provider Name | Mary Conners |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013906163 PECOS PAC ID: 6103892724 Enrollment ID: I20240813000015 |
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 | |