| Institute Of Internal Medicine P A | |
|
1301 Plantation Island Dr S Ste 402b St Augustine FL 32080-3108 | |
| (904) 460-0707 | |
| Not Available |
| Full Name | Institute Of Internal Medicine P A |
|---|---|
| Speciality | Internal Medicine |
| Location | 1301 Plantation Island Dr S, St Augustine, Florida |
| Authorized Official Name and Position | Carmen C Vivero (PRESIDENT) |
| Authorized Official Contact | 9044600707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Institute Of Internal Medicine P A 1301 Plantation Island Dr S Ste 402-b St Augustine FL 32080-3108 Ph: (904) 460-0707 | Institute Of Internal Medicine P A 1301 Plantation Island Dr S Ste 402b St Augustine FL 32080-3108 Ph: (904) 460-0707 |
| NPI Number | 1457523003 |
|---|---|
| Provider Enumeration Date | 03/24/2008 |
| Last Update Date | 09/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457523003 | NPI | - | NPPES |
| DN9360 | Other | FL | RR MEDICARE |
| 44784 | Other | FL | BCBS |
| 003271700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME76599 (Florida) | Primary |
| 207RA0401X | Internal Medicine - Addiction Medicine | ME76599 (Florida) | Secondary |
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