| Sandestin Clinical Services, Llc | |
|
400 Audubon Dr Miramar Beach FL 32550-4594 | |
| (850) 267-6767 | |
| Not Available |
| Full Name | Sandestin Clinical Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 400 Audubon Dr, Miramar Beach, Florida |
| Authorized Official Name and Position | Angel Barber (ADMINISTRATOR) |
| Authorized Official Contact | 8502676767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandestin Clinical Services, Llc 15000 Emerald Coast Pkwy Destin FL 32541-3338 Ph: () - | Sandestin Clinical Services, Llc 400 Audubon Dr Miramar Beach FL 32550-4594 Ph: (850) 267-6767 |
| NPI Number | 1154743722 |
|---|---|
| Provider Enumeration Date | 01/15/2014 |
| Last Update Date | 01/15/2014 |
| Medicare PECOS PAC ID | 5698099166 |
|---|---|
| Medicare Enrollment ID | O20150112001041 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154743722 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Hien Ngoc Dao |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1699779389 PECOS PAC ID: 8527965201 Enrollment ID: I20031219000127 |
| Provider Name | Barrington R Owens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568401784 PECOS PAC ID: 8628045358 Enrollment ID: I20040913001103 |
| Provider Name | Thomas John |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013095603 PECOS PAC ID: 2466550710 Enrollment ID: I20070609000115 |
| Provider Name | Rachel K Trimm-scarborough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215176706 PECOS PAC ID: 7810040938 Enrollment ID: I20150325001532 |
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