| Av Medical Center Inc. | |
|
1301 N Lawnwood Cir Fort Pierce FL 34950-4825 | |
| (772) 577-6232 | |
| (305) 402-0941 |
| Full Name | Av Medical Center Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1301 N Lawnwood Cir, Fort Pierce, Florida |
| Authorized Official Name and Position | Walsin Romero (OWNER) |
| Authorized Official Contact | 7865472767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Av Medical Center Inc. 3357 Sw Frankford St Port Saint Lucie FL 34953-4938 Ph: (786) 547-2767 | Av Medical Center Inc. 1301 N Lawnwood Cir Fort Pierce FL 34950-4825 Ph: (772) 577-6232 |
| NPI Number | 1245075936 |
|---|---|
| Provider Enumeration Date | 06/26/2024 |
| Last Update Date | 12/17/2024 |
| Medicare PECOS PAC ID | 2264979723 |
|---|---|
| Medicare Enrollment ID | O20240801001388 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245075936 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RP1001X | Internal Medicine - Pulmonary Disease | (* (Not Available)) | Primary |
| Provider Name | Dwight Garfield Dawkins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164492005 PECOS PAC ID: 5991849507 Enrollment ID: I20100220000253 |
| Provider Name | Deborah A Kicliter-kelley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144476920 PECOS PAC ID: 2365696101 Enrollment ID: I20130204000264 |
| Provider Name | Armand J Bermudez |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1649274929 PECOS PAC ID: 4284520487 Enrollment ID: I20150109000151 |
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