| Tailored Healthcare Inc | |
|
32 S 5th St Macclenny FL 32063-2302 | |
| (904) 259-5929 | |
| Not Available |
| Full Name | Tailored Healthcare Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 32 S 5th St, Macclenny, Florida |
| Authorized Official Name and Position | Robert M Lancaster (OWNER) |
| Authorized Official Contact | 9042595929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tailored Healthcare Inc 32 S 5th St Macclenny FL 32063-2302 Ph: (904) 259-5929 | Tailored Healthcare Inc 32 S 5th St Macclenny FL 32063-2302 Ph: (904) 259-5929 |
| NPI Number | 1558086033 |
|---|---|
| Provider Enumeration Date | 10/07/2022 |
| Last Update Date | 10/07/2022 |
| Certification Date | 10/07/2022 |
| Medicare PECOS PAC ID | 7315316239 |
|---|---|
| Medicare Enrollment ID | O20221214003197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558086033 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Primary |
| Provider Name | Robert Markham Lancaster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558488072 PECOS PAC ID: 6103926118 Enrollment ID: I20070705000097 |
| Provider Name | Kassie Crews Shoup |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578028478 PECOS PAC ID: 8325387913 Enrollment ID: I20190226001156 |
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