SOUTH LAKE INTERNAL MEDICINE PA NPI 1801838313

NPI Information

NPI: 1801838313
Provider Name: SOUTH LAKE INTERNAL MEDICINE PA
Classification: Family Medicine - 207QA0505X
Entity Type: Organization

Specialization: Adult Medicine

Address:
1371 CITRUS TOWER BLVD
CLERMONT, FL
ZIP 34711
Phone: (352) 243-2141
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SOUTH LAKE INTERNAL MEDICINE PA is an adult medicine family medicine in Clermont, FL. The provider is definition to come. SOUTH LAKE INTERNAL MEDICINE PA NPI is 1801838313. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1371 CITRUS TOWER BLVD
CLERMONT, FL
ZIP 34711-924
Phone: (352) 243-2141
Fax: (352) 243-1309

The provider's authorized official is James M Ray .
The authorized official title is President and has the following contact phone number (352) 394-1969.

The enumeration date for this NPI number is 6/11/2006 and was last updated on 9/18/2008.

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	207QA0505X	Family Medicine	Adult Medicine			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	K-5621	MEDICARE PIN	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: 11/14/2023

NPI Synchronization or Removal

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