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Organization
PEDIM OUTREACH AND SPECIALTY CLINIC LLC
Active
Organization
PEDIM OUTREACH AND SPECIALTY CLINIC LLC
Active
Other names
PEDIM Outreach Inverness
Organization subpart
No
Provider details
NPI number
Authorized official
DACELIN ST MARTIN MD (OWNER)
(352) 684-8736
Entity
Organization
Contact information
Practice address
3565 E SUZIE LN, INVERNESS, FL 34452-3250
(352) 527-6888
Mailing address
PO BOX 2066, LECANTO, FL 34460-2066
(352) 634-8736
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
04/24/2023
Last updated
02/13/2025
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