| UF Health Family Medicine - Old Town | |
|
25827 Se Highway 19 Old Town FL 32680-3997 | |
| (352) 265-7922 | |
| Not Available |
| Full Name | UF Health Family Medicine - Old Town |
|---|---|
| Speciality | Family Medicine |
| Location | 25827 Se Highway 19, Old Town, Florida |
| Authorized Official Name and Position | William W Tharp (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Contact | 3522658017 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| UF Health Family Medicine - Old Town Po Box 13833 Philadelphia PA 19101-3833 | UF Health Family Medicine - Old Town 25827 Se Highway 19 Old Town FL 32680-3997 Ph: (352) 265-7922 |
| NPI Number | 1629138292 |
|---|---|
| Provider Enumeration Date | 12/12/2006 |
| Last Update Date | 12/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629138292 | NPI | - | NPPES |
| 053386614 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 208000000X | Pediatrics | () | Secondary |
| 363A00000X | Physician Assistant | () | Secondary |
| 363L00000X | Nurse Practitioner | () | Secondary |