Provider Demographics
NPI:1609316975
Name:GAINESVILLE MEDICAL OBESITY SPECIALTY CLINIC LLC
Entity Type:Organization
Organization Name:GAINESVILLE MEDICAL OBESITY SPECIALTY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LARIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-672-9000
Mailing Address - Street 1:6830 NW 11TH PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4254
Mailing Address - Country:US
Mailing Address - Phone:352-672-9000
Mailing Address - Fax:352-505-8552
Practice Address - Street 1:6830 NW 11TH PL
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4254
Practice Address - Country:US
Practice Address - Phone:352-672-9000
Practice Address - Fax:352-505-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054910261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062219200Medicaid
FL062219200Medicaid