| Sandford H Kinne Iii D O P A | |
|
290 Clyde Morris Blvd Suite A-1 Ormond Beach FL 32174-8130 | |
| (386) 677-5600 | |
| (386) 677-5686 |
| Full Name | Sandford H Kinne Iii D O P A |
|---|---|
| Speciality | Family Medicine |
| Location | 290 Clyde Morris Blvd, Ormond Beach, Florida |
| Authorized Official Name and Position | Sandford Halsey Kinne (OWNER/SELF) |
| Authorized Official Contact | 3866775600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandford H Kinne Iii D O P A Po Box 731869 Ormond Beach FL 32173-1869 Ph: (386) 677-5600 | Sandford H Kinne Iii D O P A 290 Clyde Morris Blvd Suite A-1 Ormond Beach FL 32174-8130 Ph: (386) 677-5600 |
| NPI Number | 1942435920 |
|---|---|
| Provider Enumeration Date | 05/20/2009 |
| Last Update Date | 05/20/2009 |
| Medicare PECOS PAC ID | 2062562978 |
|---|---|
| Medicare Enrollment ID | O20090616000324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942435920 | NPI | - | NPPES |
| 375409000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS0006791 (Florida) | Primary |
| Provider Name | Sandford H Kinne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043328735 PECOS PAC ID: 5890845705 Enrollment ID: I20090616000304 |
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