EAST LAKE MEDICAL CLINIC (NPI# 1790124741) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790124741 |
| Entity Type | Organization |
| Organization Name | EAST LAKE MEDICAL CLINIC |
| Practice Address |
4737 Old Canoe Creek Rd Saint Cloud FL 34769-1400 |
| Practice Telephone | 4077053222 |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2013-06-21 |
| Authorized Official Name | DR. DUSTIN LY (PRESIDENT) |
| Authorized Official Telephone | 4077053222 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
ME114777 | FL | Ambulatory Health Care Facilities |
| Street Address |
4737 OLD CANOE CREEK RD |
| City | SAINT CLOUD |
| State | FL |
| Zip Code | 34769-1400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710195268 | Dustin N Ly | Internal Medicine | 4737 Old Canoe Creek Rd, Saint Cloud, FL 34769-1400 | 2007-05-18 |
| 1902362122 | Minh-chau Thi Tran | Nurse Practitioner | 4737 Old Canoe Creek Rd, Saint Cloud, FL 34769-1400 | 2019-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053877506 | Premier Med Pa | Clinic/Center | 2906 17th St., St Cloud, FL 34769 | 2019-02-20 |
| 1760975387 | Mayra Rosado | Psychologist | Carrousel Therapy Center, 3201 Budinger Ave., Saint Cloud, FL 34769 | 2018-06-08 |
| 1598282113 | Salud Urgent Care LLC | Clinic/Center | 3107 13th Street, Saint Cloud, FL 34769 | 2017-08-24 |
| 1710332671 | American Healthcare Community Behavioral Services LLC | Social Worker | 1203 Florida Ave., St. Cloud, FL 34769 | 2016-04-28 |
| 1215395785 | Elite Garden | Assisted Living Facility | 4319 Neptune Road, St Cloud, FL 34769 | 2016-01-29 |
| 1336506732 | Adventist Health System/sunbelt, Inc. | Clinic/Center | 4660 13th Street, St. Cloud, FL 34769 | 2016-01-15 |
| 1306202064 | Megan Rose Mcclave | Registered Nurse | 524 13th Street, St. Cloud, FL 34769 | 2016-01-12 |
| 1821473133 | Angela Creager | Counselor | 446 Hamilton Park Circle, St. Cloud, FL 34769 | 2015-07-28 |
| 1730574906 | Jordico LLC | Assisted Living Facility | 4417 13th Street, Suite 142, Saint Cloud, FL 34769 | 2015-04-03 |
| 1255731667 | Judimar Rodriguez | Behavioral Analyst | 1605 Eastern Ave, Saint Cloud, FL 34769 | 2014-09-04 |
| Find all providers in zip 34769 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902392525 | Odam Medical Group | Clinic/Center | 3405 3rd St N, Saint Cloud, MN 56303-4015 | 2018-07-06 |
| 1922309582 | Best of Health Medical Clinic,llc | Clinic/Center | 524 13 Th Street, Saint Cloud, FL 34769 | 2010-11-12 |
| 1518268283 | Walk In Medical Clinic and Fitness Center, LLC | Clinic/Center | 3105 Innovation Dr Ste A, Saint Cloud, FL 34769-6501 | 2010-11-10 |
| 1114414380 | Jose A Rivera | Clinic/Center | 3201 Budinger Ave, Saint Cloud, FL 34769-7203 | 2018-04-13 |
| 1730692450 | Carrousel Health Care Corporation | Clinic/Center | 3201 Budinger Ave, Saint Cloud, FL 34769-7203 | 2017-11-16 |
| 1689196339 | Centracare Clinic | Clinic/Center | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2017-07-14 |
| 1538696323 | Centracare Clinic | Clinic/Center | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2017-05-11 |
| 1336520105 | Cloud Care LLC | Clinic/Center | 3720 Cord Ave, Saint Cloud, FL 34772-8061 | 2015-06-17 |
| 1881004596 | Z Medical Center LLC | Clinic/Center | 1600 Budinger Ave Ste A, Saint Cloud, FL 34769-6007 | 2014-05-02 |
| 1457405763 | Centracare Clinic | Clinic/Center | 1900 Centracare Cir, Suite 1450, Saint Cloud, MN 56303-5000 | 2007-01-23 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 34769 |
Please comment or provide details below to improve the information on EAST LAKE MEDICAL CLINIC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.