Provider Demographics
NPI:1922306109
Name:PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS, PA
Entity Type:Organization
Organization Name:PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS, PA
Other - Org Name:SLEEP CLINIC OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DACELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-527-6673
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:352-527-6673
Mailing Address - Fax:352-527-9314
Practice Address - Street 1:1980 NORTH PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461
Practice Address - Country:US
Practice Address - Phone:352-527-6673
Practice Address - Fax:352-527-9314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic