LAKE CITY INSTITUTE OF NEUROLOGY PA (NPI# 1578922613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578922613 |
| Entity Type | Organization |
| Organization Name | LAKE CITY INSTITUTE OF NEUROLOGY PA |
| Other Organization Name | FLORIDA INSTITUTE OF NEUROLOGY |
| Practice Address |
4745 Old Canoe Creek Rd Saint Cloud FL 34769-1400 |
| Practice Telephone | 4078181664 |
| Practice Fax Number | 4078181654 |
| Mailing Telephone | 4078181664 |
| Mailing Fax Number | 4078181654 |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2020-10-14 |
| Authorized Official Name | MRS. REKHA NIDADAVOLU (MANAGER) |
| Authorized Official Telephone | 3059059316 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
ME109423 | FL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | RAILROAD MEDICARE | DS6851 | 01 |
| FL | 003957500 | 05 | |
| FL | BCBS | 14H5X | 01 |
| Other Name | Type Code |
|---|---|
| Florida Institute of Neurology | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4741 Old Canoe Creek Rd, Suite 2, Saint Cloud, FL 347691400 | 4078181664 | 4078181654 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710266895 | Lake City Institute of Neurology Pa | Psychiatry & Neurology | 4355 Nw American Ln, Lake City, FL 32055-4828 | 2011-08-08 |
| Street Address |
4745 OLD CANOE CREEK RD |
| City | SAINT CLOUD |
| State | FL |
| Zip Code | 34769-1400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902138217 | Rekha Nidadavolu | Pharmacist | 4745 Old Canoe Creek Rd, Saint Cloud, FL 34769-1400 | 2010-02-11 |
| 1124645742 | Angie Rojas | Nurse Practitioner | 4745 Old Canoe Creek Rd, Saint Cloud, FL 34769-1400 | 2020-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053877506 | Premier Med Pa | Clinic/Center | 2906 17th St., St Cloud, FL 34769 | 2019-02-20 |
| 1760975387 | Mayra Rosado | Psychologist | Carrousel Therapy Center, 3201 Budinger Ave., Saint Cloud, FL 34769 | 2018-06-08 |
| 1598282113 | Salud Urgent Care LLC | Clinic/Center | 3107 13th Street, Saint Cloud, FL 34769 | 2017-08-24 |
| 1710332671 | American Healthcare Community Behavioral Services LLC | Social Worker | 1203 Florida Ave., St. Cloud, FL 34769 | 2016-04-28 |
| 1215395785 | Elite Garden | Assisted Living Facility | 4319 Neptune Road, St Cloud, FL 34769 | 2016-01-29 |
| 1336506732 | Adventist Health System/sunbelt, Inc. | Clinic/Center | 4660 13th Street, St. Cloud, FL 34769 | 2016-01-15 |
| 1306202064 | Megan Rose Mcclave | Registered Nurse | 524 13th Street, St. Cloud, FL 34769 | 2016-01-12 |
| 1821473133 | Angela Creager | Counselor | 446 Hamilton Park Circle, St. Cloud, FL 34769 | 2015-07-28 |
| 1730574906 | Jordico LLC | Assisted Living Facility | 4417 13th Street, Suite 142, Saint Cloud, FL 34769 | 2015-04-03 |
| 1255731667 | Judimar Rodriguez | Behavioral Analyst | 1605 Eastern Ave, Saint Cloud, FL 34769 | 2014-09-04 |
| Find all providers in zip 34769 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| 1790201739 | Centracare Clinic | Clinic/Center | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2017-08-22 |
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| Find all providers with the same taxonomy | ||||
| City | SAINT CLOUD |
| Zip Code | 34769 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.