| Innocent Odocha Md Pa | |
|
816 Nw 13th St Gainesville FL 32601-2903 | |
| (352) 371-3212 | |
| (352) 371-3213 |
| Full Name | Innocent Odocha Md Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 816 Nw 13th St, Gainesville, Florida |
| Authorized Official Name and Position | Innocent Odocha (PRESIDENT) |
| Authorized Official Contact | 3523713212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innocent Odocha Md Pa 816 Nw 13th St Gainesville FL 32601-2903 Ph: (352) 371-3212 | Innocent Odocha Md Pa 816 Nw 13th St Gainesville FL 32601-2903 Ph: (352) 371-3212 |
| NPI Number | 1780709998 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 05/14/2009 |
| Medicare PECOS PAC ID | 6204961741 |
|---|---|
| Medicare Enrollment ID | O20100323000157 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780709998 | NPI | - | NPPES |
| 266453400 | Medicaid | FL | |
| P00179043 | Other | RAILROAD MEDICARE | |
| 57823 | Other | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | ME86683 (Florida) | Primary |
| Provider Name | Innocent N Odocha |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568560829 PECOS PAC ID: 6406981943 Enrollment ID: I20100323000136 |
| Provider Name | Alexandra R Odocha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356500771 PECOS PAC ID: 6305031170 Enrollment ID: I20101108000273 |
| Provider Name | Katherine M Swan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245671452 PECOS PAC ID: 3274775705 Enrollment ID: I20130813000977 |
| Provider Name | Cody Gerhart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437501608 PECOS PAC ID: 4183981236 Enrollment ID: I20171129000064 |
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