Provider Demographics
NPI:1093253890
Name:MED EQUITY PARTNERS, LLC
Entity Type:Organization
Organization Name:MED EQUITY PARTNERS, LLC
Other - Org Name:STOCKHAMMER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-736-1105
Mailing Address - Street 1:2370 E INTERNATIONAL SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-2744
Mailing Address - Country:US
Mailing Address - Phone:386-736-1105
Mailing Address - Fax:386-736-3860
Practice Address - Street 1:2370 E INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-2744
Practice Address - Country:US
Practice Address - Phone:386-736-1105
Practice Address - Fax:386-736-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty