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Organization
PEDIM OUTREACH AND SPECIALTY CLINIC LLC
Active
Organization
PEDIM OUTREACH AND SPECIALTY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DACELIN ST MARTIN MD (OWNER)
(352) 527-6888
Entity
Organization
Contact information
Practice address
2805 W FLARE LN, LECANTO, FL 34461
(352) 527-6888
Mailing address
PO BOX 2066, LECANTO, FL 34460-2066
(352) 634-8736
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
03/04/2024
Last updated
02/13/2025
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