| Tui Family Medicine Pl | |
|
4554 S Clyde Morris Blvd Suite 2 Port Orange FL 32129-5403 | |
| (386) 304-2990 | |
| Not Available |
| Full Name | Tui Family Medicine Pl |
|---|---|
| Speciality | Clinic/Center |
| Location | 4554 S Clyde Morris Blvd, Port Orange, Florida |
| Authorized Official Name and Position | Anunporn Srisawat (MANAGING MEMBER) |
| Authorized Official Contact | 3863042990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tui Family Medicine Pl Po Box 290035 Port Orange FL 32129-0035 Ph: () - | Tui Family Medicine Pl 4554 S Clyde Morris Blvd Suite 2 Port Orange FL 32129-5403 Ph: (386) 304-2990 |
| NPI Number | 1386940013 |
|---|---|
| Provider Enumeration Date | 01/27/2011 |
| Last Update Date | 10/12/2011 |
| Medicare PECOS PAC ID | 7911182407 |
|---|---|
| Medicare Enrollment ID | O20110427000251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386940013 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | ME 95967 (Florida) | Primary |
| Provider Name | Anunporn Srisawat |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295925030 PECOS PAC ID: 3678661378 Enrollment ID: I20071114000036 |
| Provider Name | Lisa J Jimenez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932637543 PECOS PAC ID: 2264838200 Enrollment ID: I20210831001296 |
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