| Holley-navarre Medical Clinic Llc | |
|
7552 Navarre Pkwy Ste 28 Navarre FL 32566-0525 | |
| (850) 939-3999 | |
| (850) 939-3935 |
| Full Name | Holley-navarre Medical Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 7552 Navarre Pkwy Ste 28, Navarre, Florida |
| Authorized Official Name and Position | Joel Rudman (PRESIDENT) |
| Authorized Official Contact | 8509393999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holley-navarre Medical Clinic Llc Po Box 5525 Navarre FL 32566-0525 Ph: () - | Holley-navarre Medical Clinic Llc 7552 Navarre Pkwy Ste 28 Navarre FL 32566-0525 Ph: (850) 939-3999 |
| NPI Number | 1700071693 |
|---|---|
| Provider Enumeration Date | 09/13/2007 |
| Last Update Date | 11/27/2012 |
| Medicare PECOS PAC ID | 2264463397 |
|---|---|
| Medicare Enrollment ID | O20050829000118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700071693 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0074016 (Florida) | Primary |
| Provider Name | Joel D Rudman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336195346 PECOS PAC ID: 8325030885 Enrollment ID: I20050521000016 |
| Provider Name | Sherrie M Koenigseder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205372976 PECOS PAC ID: 3173808763 Enrollment ID: I20170322001069 |
| Provider Name | Patricia Ann Burnett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295231421 PECOS PAC ID: 0648535922 Enrollment ID: I20180607003142 |
| Provider Name | William Dolphus Kimbrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831715804 PECOS PAC ID: 2365482379 Enrollment ID: I20201111000366 |
| Provider Name | Michael K Rushing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386373082 PECOS PAC ID: 3678513504 Enrollment ID: I20220921003975 |
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