| Grace Family Medicine Direct Primary Care Of Wellington | |
|
12788 Forest Hill Blvd Ste 1004 Wellington FL 33414-4703 | |
| (561) 331-5155 | |
| (561) 907-6019 |
| Full Name | Grace Family Medicine Direct Primary Care Of Wellington |
|---|---|
| Speciality | Family Medicine |
| Location | 12788 Forest Hill Blvd Ste 1004, Wellington, Florida |
| Authorized Official Name and Position | Carlos Poveda (MANAGER) |
| Authorized Official Contact | 5613172389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Family Medicine Direct Primary Care Of Wellington 11191 Grandview Mnr Wellington FL 33414-8840 Ph: (561) 317-2389 | Grace Family Medicine Direct Primary Care Of Wellington 12788 Forest Hill Blvd Ste 1004 Wellington FL 33414-4703 Ph: (561) 331-5155 |
| NPI Number | 1831712801 |
|---|---|
| Provider Enumeration Date | 05/25/2020 |
| Last Update Date | 12/06/2021 |
| Medicare PECOS PAC ID | 3274944145 |
|---|---|
| Medicare Enrollment ID | O20201125000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831712801 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Leon A Poveda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508801242 PECOS PAC ID: 0244323632 Enrollment ID: I20070830000214 |
| Provider Name | Jessica Mendez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194100073 PECOS PAC ID: 4284932062 Enrollment ID: I20160411002296 |
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