Southlake Family Practice Pa in St Augustine - Primary Care
Southlake Family Practice Pa - NPI 1225247810
Southlake Family Practice Pa is a Primary Care in St Augustine, Florida. Southlake Family Practice Pa practices all healthcare services and medical treatments related to Primary Care. The NPI Number for Southlake Family Practice Pa is 1225247810. The last update date is 2011-09-29.
Southlake Family Practice Pa's current location address is 308 Kingsley Lake Dr Ste 802, St Augustine, Florida. You can contact this provider via phone number 9048270788. The mailing address for Southlake Family Practice Pa is 308 Kingsley Lake Dr Ste 802, St Augustine, Florida. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Southlake Family Practice Pa |
|---|---|
| Address | 308 Kingsley Lake Dr Ste 802, St Augustine, Florida |
| Phone Number | 9048270788 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | MEDICAL DI |
|---|---|
| Authorized Official Name | Kaluza Malgorzata |
| Credentials | MD |
| Telephone Number | 9048270788 |
NPI Number Detail
| NPI Number | 1225247810 |
|---|---|
| Provider Enumeration Date | 2007-05-21 |
| Last Updated Date | 2011-09-29 |
Provider Mailing Address Detail
| Address | 308 Kingsley Lake Dr Ste 802 |
|---|---|
| City | St Augustine |
| State | Florida (FL) |
| Post Code | 320923046 |
| Phone Number | 9048270788 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Primary Care |
|---|---|
| Taxonomy | 261Qp2300X |
| Licence No | ME79394 |
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Definition: Serves as the first point of contact for comprehensive healthcare services. |
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Post Comment/ Review Below
What is the unique identifier code issued to Southlake Family Practice Pa by the Centers for Medicare & Medicaid Services (CMS)?
The Southlake Family Practice Pa has been assigned the NPI (National Provider Identifier) 1225247810. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Could you please provide the complete physical location address of Southlake Family Practice Pa?
The Southlake Family Practice Pa is physically situated at 308 Kingsley Lake Dr Ste 802, in the city of St Augustine, state of FL, with the postal code 320923046.
What is Southlake Family Practice Pa's area of expertise and its corresponding taxonomy classification?
The Southlake Family Practice Pa's field of specialization is Primary Care, and it falls under the taxonomy code 261Qp2300X, which categorizes healthcare providers based on their areas of practice.
On what date did the Centers for Medicare & Medicaid Services assign the 1225247810 to Southlake Family Practice Pa?
The Centers for Medicare & Medicaid Services assigned the 1225247810 to Southlake Family Practice Pa on 2007-05-21.
When was the information pertaining to Southlake Family Practice Pa most recently updated or revised?
The details related to Southlake Family Practice Pa, including its address, specialty, and other relevant information, were last updated or revised on 2011-09-29.
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