Provider Demographics
NPI:1841885639
Name:SEDONA ENTERPRISES
Entity type:Organization
Organization Name:SEDONA ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-694-6331
Mailing Address - Street 1:6160 SW HIGHWAY 200 UNIT 119
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-8307
Mailing Address - Country:US
Mailing Address - Phone:352-694-6331
Mailing Address - Fax:
Practice Address - Street 1:841 S PONCE DE LEON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6008
Practice Address - Country:US
Practice Address - Phone:904-907-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty