| Pediatrics & Family Medicine Of Buena Vista , Llc | |
|
10552 Nw 13th Ave Gainesville FL 32606-8088 | |
| (678) 570-5063 | |
| Not Available |
| Full Name | Pediatrics & Family Medicine Of Buena Vista , Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10552 Nw 13th Ave, Gainesville, Florida |
| Authorized Official Name and Position | Bilal Khodr (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3522131243 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatrics & Family Medicine Of Buena Vista , Llc 519 Buena Vista St Lakeland FL 33805-4504 Ph: () - | Pediatrics & Family Medicine Of Buena Vista , Llc 10552 Nw 13th Ave Gainesville FL 32606-8088 Ph: (678) 570-5063 |
| NPI Number | 1053747188 |
|---|---|
| Provider Enumeration Date | 09/20/2013 |
| Last Update Date | 09/20/2013 |
| Medicare PECOS PAC ID | 1254686355 |
|---|---|
| Medicare Enrollment ID | O20180613001756 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053747188 | NPI | - | NPPES |
| 252009500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | ME0072652 (Florida) | Primary |
| Provider Name | Bilal M Khodr |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881653723 PECOS PAC ID: 3072578152 Enrollment ID: I20041130001138 |
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