# PEDIM OUTREACH AND SPECIALTY CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558128819
- **Authorized official:** DACELIN ST MARTIN MD (OWNER)
- **Authorized official phone:** (352) 527-6888

## Contact information

- **Practice address:** 2805 W FLARE LN, LECANTO, FL 34461
- **Practice address phone:** (352) 527-6888
- **Mailing address:** PO BOX 2066, LECANTO, FL 34460-2066
- **Mailing address phone:** (352) 634-8736

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 03/04/2024
- **Last updated:** 02/13/2025