Healthcare Provider Details

I. General information

NPI: 1861710428
Provider Name (Legal Business Name): SLV MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 SE 12TH ST. BUILDING 200
OCALA FL
34471
US

IV. Provider business mailing address

316 SE 12TH ST. BUILDING 200
OCALA FL
34471
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA LYNN THORSTENSON
Title or Position: CONTACT
Credential:
Phone: 352-348-5611