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165 Sw Vision Glenn Lake City FL 32025-1111 | |
| (386) 755-1800 | |
| (386) 758-8770 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 165 Sw Vision Glenn, Lake City, Florida |
| Authorized Official Name and Position | Shilpa U. Mhatre (OFFICE MANAGER) |
| Authorized Official Contact | 3867551800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
165 Sw Vision Glenn Lake City FL 32025-1111 Ph: (386) 755-1800 | 165 Sw Vision Glenn Lake City FL 32025-1111 Ph: (386) 755-1800 |
| NPI Number | 1962552752 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 02/14/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962552752 | NPI | - | NPPES |
| 264574342 | Other | FL | CHAMPUS TRICARE |
| ME 0027561 | Other | FL | FLORIDA LICENSE |
| 01251 | Other | FL | BC BS OF FL |
| 037553500 | Medicaid | FL | |
| 083097 | Other | FL | MHN |
| 406263894 | Other | FL | RAIL ROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME0027561 (Florida) | Primary |
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