| Promise Medical Group, Pllc | |
|
9202 Nw 26th St Wildwood FL 34785-7413 | |
| (352) 812-0579 | |
| (352) 571-4349 |
| Full Name | Promise Medical Group, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 9202 Nw 26th St, Wildwood, Florida |
| Authorized Official Name and Position | David Wayne Stephenson (PRESIDENT) |
| Authorized Official Contact | 3528120579 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Promise Medical Group, Pllc 9202 Nw 26th St Wildwood FL 34785-7413 Ph: (352) 812-0579 | Promise Medical Group, Pllc 9202 Nw 26th St Wildwood FL 34785-7413 Ph: (352) 812-0579 |
| NPI Number | 1043560832 |
|---|---|
| Provider Enumeration Date | 09/19/2012 |
| Last Update Date | 07/29/2024 |
| Medicare PECOS PAC ID | 7113177304 |
|---|---|
| Medicare Enrollment ID | O20121024000529 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043560832 | NPI | - | NPPES |
| FD876Z | Other | FL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME106525 (Florida) | Primary |
| Provider Name | David W Stephenson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093983157 PECOS PAC ID: 6608044243 Enrollment ID: I20110726000234 |
| Provider Name | Asm M. Rahman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871789487 PECOS PAC ID: 2264603992 Enrollment ID: I20110928000836 |
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