| Southern Medicine Primary & Urgent Care, Inc | |
|
1405 Ohio Ave N Live Oak FL 32064-4868 | |
| (386) 209-0638 | |
| (386) 219-0470 |
| Full Name | Southern Medicine Primary & Urgent Care, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1405 Ohio Ave N, Live Oak, Florida |
| Authorized Official Name and Position | Michelle Morris (PRESIDENT) |
| Authorized Official Contact | 3862090638 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Medicine Primary & Urgent Care, Inc Po Box 6006 Live Oak FL 32064-6006 Ph: () - | Southern Medicine Primary & Urgent Care, Inc 1405 Ohio Ave N Live Oak FL 32064-4868 Ph: (386) 209-0638 |
| NPI Number | 1841815826 |
|---|---|
| Provider Enumeration Date | 06/15/2020 |
| Last Update Date | 05/17/2022 |
| Medicare PECOS PAC ID | 7012333248 |
|---|---|
| Medicare Enrollment ID | O20200818002267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841815826 | NPI | - | NPPES |
| 12624827 | Other | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Secondary |
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