| Leesburg Regional Medical Center Physician Services Llc | |
|
600 E Dixie Ave Leesburg FL 34748-5925 | |
| (523) 594-0827 | |
| (352) 323-5039 |
| Full Name | Leesburg Regional Medical Center Physician Services Llc |
|---|---|
| Speciality | Emergency Medicine |
| Location | 600 E Dixie Ave, Leesburg, Florida |
| Authorized Official Name and Position | Heather Long (PRESIDENT, CEO) |
| Authorized Official Contact | 3523235761 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leesburg Regional Medical Center Physician Services Llc 600 E Dixie Ave Leesburg FL 34748-5925 Ph: (352) 323-5002 | Leesburg Regional Medical Center Physician Services Llc 600 E Dixie Ave Leesburg FL 34748-5925 Ph: (523) 594-0827 |
| NPI Number | 1104063114 |
|---|---|
| Provider Enumeration Date | 01/13/2009 |
| Last Update Date | 11/21/2024 |
| Certification Date | 11/21/2024 |
| Medicare PECOS PAC ID | 8426107327 |
|---|---|
| Medicare Enrollment ID | O20090526000395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104063114 | NPI | - | NPPES |
| Provider Name | John Patrick Lewis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548357437 PECOS PAC ID: 7911950993 Enrollment ID: I20050308000549 |
| Provider Name | John E. Ricks |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1538133830 PECOS PAC ID: 6800851734 Enrollment ID: I20060106000243 |
| Provider Name | Michael V Orris |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235213331 PECOS PAC ID: 7012002363 Enrollment ID: I20071001000738 |
| Provider Name | Anil Kumar Gogineni |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1821267386 PECOS PAC ID: 5799858312 Enrollment ID: I20080715000743 |
| Provider Name | Michael Boyer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063429751 PECOS PAC ID: 6305747544 Enrollment ID: I20100305000806 |
| Provider Name | Michael Shamus Mchale |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568402485 PECOS PAC ID: 7113828401 Enrollment ID: I20100422000918 |
| Provider Name | Hassan Y Farhat |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922016351 PECOS PAC ID: 7416954383 Enrollment ID: I20110114000886 |
| Provider Name | Ramy Nasr |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063673630 PECOS PAC ID: 2264689488 Enrollment ID: I20131120001332 |
| Provider Name | Ramon Echague Colman |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1568710473 PECOS PAC ID: 0840431672 Enrollment ID: I20150507002633 |
| Provider Name | Jerry Stanley Voit |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174781066 PECOS PAC ID: 3971677873 Enrollment ID: I20151217002154 |
| Provider Name | Shahroz Kidwai |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013200062 PECOS PAC ID: 7618193871 Enrollment ID: I20200603000873 |
| Provider Name | Danelle Richards |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1184725764 PECOS PAC ID: 3577743319 Enrollment ID: I20230424000011 |
| Provider Name | Erik J St. Pierre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427095967 PECOS PAC ID: 4587608997 Enrollment ID: I20230830003046 |
| Provider Name | Hasina C Arre |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144781683 PECOS PAC ID: 7810373297 Enrollment ID: I20240203000027 |
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