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Contact Information

PEDIM OUTREACH AND SPECIALTY CLINIC LLC
1982 N PROSPECT AVE
LECANTO, FL34461
 Phone: 352-563-0931
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Physical Therapy

261QP2000X
 

Sleep Disorder Diagnostic

261QS1200X
 

Sleep Medicine

207RS0012X 11 Physician/Internal Medicine
 

Sleep Medicine

207QS1201X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for PEDIM OUTREACH AND SPECIALTY CLINIC LLC · (Female)

NPI Number 1851848097
Status Active
Credentials
Entity Individual
Enumeration date 09/06/2016
Last updated 05/06/2026 - About a month ago
Sole proprietor 1 Not specified
Identifiers
  • FL Medicaid 103596200
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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