| Southern Internal Medicine Pllc | |
|
404 Nw Hall Of Fame Dr Lake City FL 32055-4833 | |
| (386) 754-2433 | |
| (386) 754-2586 |
| Full Name | Southern Internal Medicine Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 404 Nw Hall Of Fame Dr, Lake City, Florida |
| Authorized Official Name and Position | Guy S Strauss (MANAGER) |
| Authorized Official Contact | 9045215388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Internal Medicine Pllc 7896 Briarwood Cir Glen Saint Mary FL 32040-4706 Ph: (904) 521-5388 | Southern Internal Medicine Pllc 404 Nw Hall Of Fame Dr Lake City FL 32055-4833 Ph: (386) 754-2433 |
| NPI Number | 1912188624 |
|---|---|
| Provider Enumeration Date | 11/21/2007 |
| Last Update Date | 11/21/2007 |
| Medicare PECOS PAC ID | 7618052580 |
|---|---|
| Medicare Enrollment ID | O20080318000015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912188624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | OS4706 (Florida) | Primary |
| Provider Name | Stefanie M Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346204427 PECOS PAC ID: 3577567551 Enrollment ID: I20060906000015 |
| Provider Name | Guy S Strauss |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578570727 PECOS PAC ID: 7911900501 Enrollment ID: I20070427000342 |
| Provider Name | Bryce C Catarelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437553161 PECOS PAC ID: 9739405531 Enrollment ID: I20150312002107 |
| Provider Name | Elaina M Williamson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053851451 PECOS PAC ID: 9133489164 Enrollment ID: I20180212001520 |
| Provider Name | Samantha A Smythe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902466881 PECOS PAC ID: 9739592148 Enrollment ID: I20210104000611 |
| Provider Name | Brittaney P Howell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316661929 PECOS PAC ID: 4284097627 Enrollment ID: I20230831003379 |
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