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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

NPI Number 1851848097
LBN Legal business name PEDIM OUTREACH AND SPECIALTY CLINIC LLC
Authorized official DACELIN ST MARTIN - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/06/2016
Last updated 05/06/2026 - About a month ago
Identifiers
FL Medicaid 103596200
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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