Organization
EXTENDED CARE MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA M MACDONALD ARNP (OWNER)
(352) 536-8140
Entity
Organization
Contact information
Practice address
1730 E HWY 50, PMB 4, CLERMONT, FL 34711-2778
(352) 408-5955
(352) 536-8141
Mailing address
1730 E HWY 50, CLERMONT, FL 34711-2778
(352) 408-5955
(352) 536-8141
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305309100
—
FL
Enumeration date
07/15/2011
Last updated
07/15/2011
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