Provider Demographics
NPI:1659056117
Name:PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS INC
Entity Type:Organization
Organization Name:PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED SPEC
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAJOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-634-8736
Mailing Address - Street 1:PO BOX 2066
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460-2066
Mailing Address - Country:US
Mailing Address - Phone:352-684-8736
Mailing Address - Fax:
Practice Address - Street 1:2385 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9677
Practice Address - Country:US
Practice Address - Phone:352-527-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty