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General NPI Number Information
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NPI Number | 1639375165
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Entity Type | Organization
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Legal Business Name | SUN 'N LAKE MEDICAL GROUP,PA
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 4958 SUN N LAKE BLVD
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City | SEBRING
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State | FL
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Zip | 33872-2167
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Country | US
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Telephone | 863-385-8004
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Fax | 863-385-2330
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Provider Business Mailing Address
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Address Line | 4958 SUN N LAKE BLVD
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City | SEBRING
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State | FL
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Zip | 33872-2167
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Country | US
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Telephone | 863-385-8004
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Fax | 863-385-2330
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIGUEL F BELTRE
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Credential | M.D
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Telephone | 863-385-2659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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