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25827 Se Highway 19 Old Town FL 32680-3997 | |
(352) 265-7922 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 25827 Se Highway 19, Old Town, Florida |
Authorized Official Name and Position | William W Tharp (EXECUTIVE VICE PRESIDENT) |
Authorized Official Contact | 3522658017 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 13833 Philadelphia PA 19101-3833 Ph: () - | 25827 Se Highway 19 Old Town FL 32680-3997 Ph: (352) 265-7922 |
NPI Number | 1629138292 |
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Provider Enumeration Date | 12/12/2006 |
Last Update Date | 12/28/2015 |
Identifier | Type | State | Issuer |
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1629138292 | NPI | - | NPPES |
053386614 | Medicaid | FL |