Provider Demographics
NPI:1225085327
Name:MARION OAKS MEDICAL CLINIC OF CENTRAL FLORIDA INC
Entity Type:Organization
Organization Name:MARION OAKS MEDICAL CLINIC OF CENTRAL FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EWERE
Authorized Official - Last Name:OKOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-347-5444
Mailing Address - Street 1:13795 SW 36TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-6104
Mailing Address - Country:US
Mailing Address - Phone:352-347-5444
Mailing Address - Fax:352-347-3162
Practice Address - Street 1:13795 SW 36TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-6104
Practice Address - Country:US
Practice Address - Phone:352-347-5444
Practice Address - Fax:352-347-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269599500Medicaid
FL269599500Medicaid