Provider Demographics
NPI:1770179590
Name:MINI HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:MINI HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEMEISHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-227-3000
Mailing Address - Street 1:1028 GLENRAVEN LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9008
Mailing Address - Country:US
Mailing Address - Phone:407-733-3923
Mailing Address - Fax:
Practice Address - Street 1:1150 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2507
Practice Address - Country:US
Practice Address - Phone:352-227-3000
Practice Address - Fax:352-505-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty