| Mission Family Medicine Llc | |
|
1785 Garden St Titusville FL 32796-3221 | |
| (321) 269-9612 | |
| (321) 269-8433 |
| Full Name | Mission Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1785 Garden St, Titusville, Florida |
| Authorized Official Name and Position | Katie Fontaine (ADMINISTRATOR) |
| Authorized Official Contact | 3212699612 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mission Family Medicine Llc 1785 Garden St Titusville FL 32796-3221 Ph: (321) 269-9612 | Mission Family Medicine Llc 1785 Garden St Titusville FL 32796-3221 Ph: (321) 269-9612 |
| NPI Number | 1699447086 |
|---|---|
| Provider Enumeration Date | 10/04/2021 |
| Last Update Date | 10/25/2021 |
| Medicare PECOS PAC ID | 2769869593 |
|---|---|
| Medicare Enrollment ID | O20220517003253 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699447086 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Benjamin Grant Marshall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922369859 PECOS PAC ID: 1456661107 Enrollment ID: I20191008003594 |
| Provider Name | Miranda B Marshall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083973689 PECOS PAC ID: 3476987587 Enrollment ID: I20191226000796 |
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