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NPI Code Detail

MEDICARE: PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS INC

MEDICARE: PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2208000000XPediatrics Physician
3246RM2200XMedical Laboratory Technician
4261QS1200XSleep Disorder Diagnostic Clinic/Center
5261Q00000XClinic/Center10D1050573FL
6261QP2000XPhysical Therapy Clinic/Center
7332B00000XDurable Medical Equipment & Medical Supplies
8207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1396805115
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS INC
Provider Business Mailing Address
First Line : PO BOX 2066
Second Line :
City : LECANTO
State : FL
Zip : 34460-2066
Country : US
Telephone Number : 352-527-6888
Fax Number : 352-527-8818
Provider Business Practice Location Address
First Line : 1990 N PROSPECT AVE
Second Line :
City : LECANTO
State : FL
Zip : 34461-9792
Country : US
Telephone Number : 352-527-6888
Fax Number : 352-527-8818
Authorized Official
Title or Position : MEDICAL DIRECTOR/OWNER
Name : DR. DACELIN ST. MARTIN
Credential : MD
Telephone Number : 352-527-6888
Provider Enumeration Date : 12/11/2006
Last Update Date : 02/13/2025

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