| Wisdo Family Medicine, James John Wisdo DO PA | |
|
2685 Sw 32nd Pl Ste 500 Ocala FL 34471-7867 | |
| (352) 622-9007 | |
| (352) 622-2179 |
| Full Name | Wisdo Family Medicine, James John Wisdo DO PA |
|---|---|
| Speciality | Family Medicine |
| Location | 2685 Sw 32nd Pl Ste 500, Ocala, Florida |
| Authorized Official Name and Position | Janice E Medley (OFFICE MANAGER) |
| Authorized Official Contact | 3526229007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisdo Family Medicine, James John Wisdo DO PA 2685 Sw 32nd Pl Ste 500 Ocala FL 34471-7867 Ph: (352) 622-9007 | Wisdo Family Medicine, James John Wisdo DO PA 2685 Sw 32nd Pl Ste 500 Ocala FL 34471-7867 Ph: (352) 622-9007 |
| NPI Number | 1053458455 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 07/21/2020 |
| Certification Date | 07/21/2020 |
| Medicare PECOS PAC ID | 1456315282 |
|---|---|
| Medicare Enrollment ID | O20041112000137 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053458455 | NPI | - | NPPES |
| 253125900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Secondary |
| 207Q00000X | Family Medicine | (Florida) | Primary |
| Provider Name | James John Wisdo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508837998 PECOS PAC ID: 4385605823 Enrollment ID: I20041019000886 |
| Provider Name | Trisha M Kimball |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467900142 PECOS PAC ID: 0244586410 Enrollment ID: I20180629001387 |
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