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173 Nw Albritton Ln Lake City FL 32055-0249 | |
| (386) 758-5552 | |
| (386) 752-9143 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 173 Nw Albritton Ln, Lake City, Florida |
| Authorized Official Name and Position | John T Myles (CEO) |
| Authorized Official Contact | 3867585552 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 249 Lake City FL 32056-0249 Ph: (386) 758-5552 | 173 Nw Albritton Ln Lake City FL 32055-0249 Ph: (386) 758-5552 |
| NPI Number | 1962464248 |
|---|---|
| Provider Enumeration Date | 04/04/2006 |
| Last Update Date | 10/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962464248 | NPI | - | NPPES |
| 023552300 | Medicaid | FL | |
| 292277100 | Medicaid | FL | |
| ME92183 | Other | FL | STATE LICENSE |
| 033364600 | Medicaid | FL | |
| PA9101298 | Other | FL | FLORIDA LICENSE |
| 5080000065 | Other | FL | ORIGINAL LICENSE |
| PA0003548 | Other | FL | FLORIDA LICENSE |
| 1181972 | Other | FL | FLORIDA LICENSE |
| 273713200 | Medicaid | FL | |
| 290374100 | Medicaid | FL |
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