| Lake Health Care Center Inc | |
|
910 Mount Homer Rd Eustis FL 32726-6258 | |
| (352) 357-8615 | |
| Not Available |
| Full Name | Lake Health Care Center Inc |
|---|---|
| Speciality | Chiropractor |
| Location | 910 Mount Homer Rd, Eustis, Florida |
| Authorized Official Name and Position | Lorri J Hartley (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 3523578615 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Health Care Center Inc 910 Mount Homer Rd Eustis FL 32726-6258 Ph: (352) 357-8615 | Lake Health Care Center Inc 910 Mount Homer Rd Eustis FL 32726-6258 Ph: (352) 357-8615 |
| NPI Number | 1104829316 |
|---|---|
| Provider Enumeration Date | 05/23/2005 |
| Last Update Date | 06/22/2010 |
| Medicare PECOS PAC ID | 9830285444 |
|---|---|
| Medicare Enrollment ID | O20071012000128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104829316 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | NOTREQUIRED (Florida) | Secondary |
| 213E00000X | Podiatrist | NOTREQUIRED (Florida) | Secondary |
| 111N00000X | Chiropractor | NOTREQUIRED (Florida) | Primary |
| Provider Name | James S Fernandes |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1154326981 PECOS PAC ID: 1951434406 Enrollment ID: I20100804000283 |
| Provider Name | Victor M Torres |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1306841119 PECOS PAC ID: 6800936519 Enrollment ID: I20100804000326 |
| Provider Name | John F Heiligenthal |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1528063757 PECOS PAC ID: 9436282993 Enrollment ID: I20100804000392 |
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