| Dynamic Health Centers | |
|
163 Sw Stonegate Ter Ste 109 Lake City FL 32024-3459 | |
| (386) 438-8391 | |
| Not Available |
| Full Name | Dynamic Health Centers |
|---|---|
| Speciality | Clinic/Center |
| Location | 163 Sw Stonegate Ter Ste 109, Lake City, Florida |
| Authorized Official Name and Position | Melissa Distefano (PRESIDENT) |
| Authorized Official Contact | 3522625625 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dynamic Health Centers 163 Sw Stonegate Ter Ste 109 Lake City FL 32024-3459 Ph: (386) 438-8391 | Dynamic Health Centers 163 Sw Stonegate Ter Ste 109 Lake City FL 32024-3459 Ph: (386) 438-8391 |
| NPI Number | 1508181272 |
|---|---|
| Provider Enumeration Date | 04/06/2010 |
| Last Update Date | 07/29/2021 |
| Medicare PECOS PAC ID | 1052504172 |
|---|---|
| Medicare Enrollment ID | O20101021000898 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508181272 | NPI | - | NPPES |
| 006309100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | HCC8936 (Florida) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Wilbert Clifton Jacobs Ii |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124348438 PECOS PAC ID: 6709025927 Enrollment ID: I20131202001502 |
| Provider Name | Cathy R Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417239914 PECOS PAC ID: 7315268935 Enrollment ID: I20150609000093 |
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