| John R. Chewning Do Pa | |
|
1425 Hand Ave, Suite L Ormond Beach FL 32174 | |
| (386) 256-3977 | |
| (386) 872-5004 |
| Full Name | John R. Chewning Do Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1425 Hand Ave, Suite L, Ormond Beach, Florida |
| Authorized Official Name and Position | John Roy Chewning (OWNER/PRESIDENT) |
| Authorized Official Contact | 3862563977 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John R. Chewning Do Pa 1425 Hand Avenue, Suite L Ormond Beach FL 32174 Ph: (386) 256-3977 | John R. Chewning Do Pa 1425 Hand Ave, Suite L Ormond Beach FL 32174 Ph: (386) 256-3977 |
| NPI Number | 1164435277 |
|---|---|
| Provider Enumeration Date | 08/14/2006 |
| Last Update Date | 02/14/2014 |
| Medicare PECOS PAC ID | 0648274191 |
|---|---|
| Medicare Enrollment ID | O20060914000287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164435277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS8215 (Florida) | Primary |
| Provider Name | Jerry Leventhal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558364265 PECOS PAC ID: 3678569514 Enrollment ID: I20040424000055 |
| Provider Name | John R Chewning |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1346231966 PECOS PAC ID: 9234133893 Enrollment ID: I20060913000232 |
| Provider Name | Chester Kikla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740646504 PECOS PAC ID: 0941506869 Enrollment ID: I20160302002093 |
| Provider Name | Sadye G Dexter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831714906 PECOS PAC ID: 7911314901 Enrollment ID: I20210317002868 |
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Mark W. Lastarza, M.d., Pa. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 335 Clyde Morris Blvd, Suite 290, Ormond Beach, FL 32174 Phone: 386-672-3219 Fax: 386-672-3160 | |
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