| Durrance Medicaid Providers Llc | |
|
9257 Sw 137th St Starke FL 32091-5974 | |
| (904) 226-5719 | |
| Not Available |
| Full Name | Durrance Medicaid Providers Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9257 Sw 137th St, Starke, Florida |
| Authorized Official Name and Position | Jeffrey Durrance (OWNER) |
| Authorized Official Contact | 9042265719 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Durrance Medicaid Providers Llc 9257 Sw 137th St Starke FL 32091-5974 Ph: (904) 226-5719 | Durrance Medicaid Providers Llc 9257 Sw 137th St Starke FL 32091-5974 Ph: (904) 226-5719 |
| NPI Number | 1265199434 |
|---|---|
| Provider Enumeration Date | 11/23/2021 |
| Last Update Date | 11/23/2021 |
| Certification Date | 11/21/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265199434 | NPI | - | NPPES |
| 0043554 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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