Provider Demographics
NPI:1033500616
Name:OCALA INNOVATIVE MEDICAL, LLC
Entity Type:Organization
Organization Name:OCALA INNOVATIVE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-840-0444
Mailing Address - Street 1:5481 SW 60TH ST
Mailing Address - Street 2:UNIT 302
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7698
Mailing Address - Country:US
Mailing Address - Phone:352-840-0444
Mailing Address - Fax:
Practice Address - Street 1:5481 SW 60TH ST
Practice Address - Street 2:UNIT 302
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7698
Practice Address - Country:US
Practice Address - Phone:352-840-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty