Provider Demographics
NPI:1750409736
Name:OCALA HOSPITALIST GROUP P A
Entity type:Organization
Organization Name:OCALA HOSPITALIST GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROCKY OR LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-304-5990
Mailing Address - Street 1:910 SW 1ST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0904
Mailing Address - Country:US
Mailing Address - Phone:352-304-5990
Mailing Address - Fax:352-304-5993
Practice Address - Street 1:1431 SW 1ST AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6500
Practice Address - Country:US
Practice Address - Phone:352-304-5990
Practice Address - Fax:352-304-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
99267OtherBC/BS
FL002616400Medicaid
FLDD8892OtherRAILROAD MEDICARE
K8115Medicare PIN