DYNAMIC HEALTH CENTERS NPI 1508181272

NPI Information

NPI: 1508181272
Provider Name: DYNAMIC HEALTH CENTERS
Classification: Clinic/Center - 261QR1300X
Specialization: Rural Health
Entity Type: Organization
CLIA Number: 10D2035843
Address: 163 SW STONEGATE TER STE 109
LAKE CITY, FL
ZIP 32024
Phone: (386) 438-8391

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NPI Details

DYNAMIC HEALTH CENTERS is a rural health clinic center in Lake City, FL. DYNAMIC HEALTH CENTERS NPI is 1508181272. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

163 SW STONEGATE TER STE 109
LAKE CITY, FL
ZIP 32024-459
Phone: (386) 438-8391

The provider's authorized official is Melissa Distefano .
The authorized official title is President and has the following contact phone number (352) 262-5625.

The CLIA number assigned to this NPI record is 10D2035843 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/6/2010 and was last updated on 7/29/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		HCC8936	FLORIDA	No
2	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	006309100	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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