FM MEDICAL CLINIC LLC (NPI# 1891298790) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891298790 |
| Entity Type | Organization |
| Organization Name | FM MEDICAL CLINIC LLC |
| Practice Address |
165 Southpark Blvd St Augustine FL 32086-4101 |
| Practice Telephone | 9048238833 |
| Practice Fax Number | 9048239394 |
| Mailing Telephone | 9048238833 |
| Mailing Fax Number | 9048239394 |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | DR. SCOTT R MICHAELS (CLINIC DIRECTOR) |
| Authorized Official Telephone | 9048238833 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | DRIVERS LICENSES | M242796603210 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3560 Aia South, St Augustine Beach, FL 32086 | 9048238833 | 9048239394 |
| Street Address |
165 SOUTHPARK BLVD |
| City | ST AUGUSTINE |
| State | FL |
| Zip Code | 32086-4101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952352189 | Avanti Wellness Center Inc | Clinic/Center | 165 Southpark Blvd, Suite D, St Augustine, FL 32086-4101 | 2006-05-12 |
| 1750836086 | Kelli Mclaughlin | Nurse Practitioner | 165 Southpark Blvd, St Augustine, FL 32086-4101 | 2016-08-16 |
| 1053790246 | Fm Medical Urgent Care, Inc. | Clinic/Center | 165 Southpark Blvd, Suite C, St Augustine, FL 32086-4101 | 2015-05-21 |
| 1588091029 | Fm Medical LLC | Family Medicine | 165 Southpark Blvd, St Augustine, FL 32086-4101 | 2013-09-30 |
| 1053652099 | Fm Medical | Clinic/Center | 165 Southpark Blvd, Suite C & D, St Augustine, FL 32086-4101 | 2013-03-14 |
| 1750680591 | Marybeth Dyckes | Massage Therapist | 165 Southpark Blvd, Suite C and D, St Augustine, FL 32086-4101 | 2011-03-18 |
| 1043535412 | Juliana Joy Farrell | Chiropractor | 165 Southpark Blvd, Suite C and D, St Augustine, FL 32086-4101 | 2010-03-29 |
| 1285877092 | Denise J Nealey | Counselor | 165 Southpark Blvd, Suite C, St Augustine, FL 32086-4101 | 2009-04-08 |
| 1073755815 | Annette Zavro | Counselor | 165 Southpark Blvd, Suite D, St Augustine, FL 32086-4101 | 2009-03-25 |
| 1114169968 | Janet Griswold | Social Worker | 165 Southpark Blvd, Suite D, St Augustine, FL 32086-4101 | 2009-03-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225670037 | Ramonica Flagler | Nurse Practitioner | 3574 Us-1 South, St. Augustine, FL 32086 | 2019-10-14 |
| 1518522648 | Marissa Marie Lynch | Physician Assistant | 100 Whetstone Pl Ste 102, St Augustine, FL 32086 | 2019-05-03 |
| 1346706991 | Castillo Transportation | Non-emergency Medical Transport (VAN) | 295 North Hidden Tree Dr, Saint Augustine, FL 32086 | 2019-02-19 |
| 1790255842 | Michelle Moore | In Home Supportive Care | 135 Jenkins St. Suite 105b #265, St.augustine, FL 32086 | 2018-12-03 |
| 1649740200 | Paul James Lietz IIi | Physical Therapist | One Orthopedic Place, Saint Augustine, FL 32086 | 2018-11-27 |
| 1548764707 | Oceanside Endodontics Od St. Augustine | Dentist | 2510 U.S. 1 South, Suite B, St. Augustine, FL 32086 | 2018-03-22 |
| 1023538329 | Joseph R Edwards | Physical Therapist | 968 Espinado Avenue, St Augustine, FL 32086 | 2017-06-27 |
| 1235662032 | Jennifer L Csenge | Dentist | 4327 Us Highway 1 S, St Augustine, FL 32086 | 2017-04-07 |
| 1336683663 | Lisa Brice | Social Worker | 248 Southpark Circle East, Saint Augustine, FL 32086 | 2016-12-06 |
| 1558813303 | Bio-medical Applications of Florida, Inc. | Clinic/Center | 65 Whitehall Drive, Saint Augustine, FL 32086 | 2016-10-27 |
| Find all providers in zip 32086 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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|---|---|---|---|---|
| 1932745346 | Alpha Wave Health Centers LLC | Clinic/Center | 101 E Town Pl Ste 100, St Augustine, FL 32092-2726 | 2019-11-20 |
| 1720261076 | St Augustine Acupuncture Centre Inc | Clinic/Center | 6349 Salado Rd, St Augustine, FL 32080-7665 | 2007-12-10 |
| 1184260432 | Augustine Health Inc | Clinic/Center | 101 E Town Pl Ste 100, St Augustine, FL 32092-2726 | 2019-11-21 |
| 1316473168 | High Power Diagnosis | Clinic/Center | 2200 N Ponce De Leon Blvd, Suite 7, St Augustine, FL 32084-2600 | 2017-05-11 |
| 1417196106 | Gloria Z. Moore D.c., P.a. | Clinic/Center | 101 Whitehall Dr, Suite 102, St Augustine, FL 32086-5268 | 2009-02-19 |
| 1467649632 | Qixia Huang, M.d., P.a. | Clinic/Center | 1301 Plantation Island Dr S Ste 102a, St Augustine, FL 32080-3109 | 2007-10-01 |
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| Find all providers with the same taxonomy | ||||
| City | ST AUGUSTINE |
| Zip Code | 32086 |
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| 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.