| Ormond Internal Medicine Llc | |
|
279 S. Yonge St. Ormond Bch FL 32174 | |
| (386) 673-2133 | |
| (386) 673-2743 |
| Full Name | Ormond Internal Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 279 S. Yonge St., Ormond Bch, Florida |
| Authorized Official Name and Position | Patricia Gail Vandiepen (OWNER) |
| Authorized Official Contact | 3866732133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ormond Internal Medicine Llc 279 S. Yonge St. Ormond Bch FL 32174 Ph: (386) 673-2133 | Ormond Internal Medicine Llc 279 S. Yonge St. Ormond Bch FL 32174 Ph: (386) 673-2133 |
| NPI Number | 1023209095 |
|---|---|
| Provider Enumeration Date | 08/06/2007 |
| Last Update Date | 06/02/2022 |
| Medicare PECOS PAC ID | 8123192275 |
|---|---|
| Medicare Enrollment ID | O20080807000232 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023209095 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | OS7544 (Florida) | Primary |
| Provider Name | Patricia Vandiepen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568435659 PECOS PAC ID: 7315844818 Enrollment ID: I20031215000032 |
| Provider Name | Andrea Jean Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346717881 PECOS PAC ID: 5597008664 Enrollment ID: I20190514001228 |
| Provider Name | Jody Michele King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750097267 PECOS PAC ID: 3072987528 Enrollment ID: I20230323001211 |
| Provider Name | Ronnie J Hoelker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811319908 PECOS PAC ID: 9931322955 Enrollment ID: I20230822000665 |