Lydia V Wallace (NPI# 1215139381, PAC ID# 3072649136) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY PRACTICE.
| Nation Provider ID (NPI) | 1215139381 |
| PAC ID by PECOS | 3072649136 |
| Professional Enrollment ID | I20100327000329 |
| Full Name | Lydia V Wallace |
| Organization Legal Name | CITRUS PRIMARY CARE INC |
| Address |
10334 N Citrus Springs Blvd Citrus Springs FL 34434-3217 |
| Phone Number | 3524654001 |
| Gender | F |
| Graduation Year | 2006 |
| Primary Specialty | FAMILY PRACTICE |
| Group Practice PAC ID | 7315169992 |
| Number of Group Practice Members | 9 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 100023 | CITRUS MEMORIAL HOSPITAL |
| 100249 | SEVEN RIVERS REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 10334 N Citrus Springs Blvd, Citrus Springs, FL 34434-3217 | 3524654001 | CITRUS PRIMARY CARE INC |
| 131 S Citrus Ave, Inverness, FL 34452-4701 | 3523446930 | CITRUS PRIMARY CARE INC |
| Organization Legal Name | CITRUS PRIMARY CARE INC |
| Physicians | 10 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| April Weliever | Family Medicine | Citrus Primary Care Inc | 7648 S Florida Ave, Floral City, FL 34436-2738 |
| Jeffrey P Jordan | Internal Medicine | Citrus Primary Care Inc | 131 S Citrus Ave, Inverness, FL 34452-4701 |
| Mary R Brunzie | Family Medicine | Citrus Primary Care Inc | 7945 S Suncoast Boulevard, Suite B, Homosassa, FL 34446-5005 |
| Ghassan A Hasan | Family Medicine | Citrus Primary Care Inc | 450 W Roosevelt Boulevard, Beverly Hills, FL 34465-4233 |
| Ronald J Dortonne | Internal Medicine | Citrus Primary Care Inc | 131 S Citrus Ave, Inverness, FL 34452-4701 |
| John D Gelin | Family Medicine | Citrus Primary Care Inc | 7648 S Florida Ave, Floral City, FL 34436-2738 |
| Seema V Kamat | Family Medicine | Citrus Primary Care Inc | 7648 S Florida Ave, Floral City, FL 34436-2738 |
| Darlene B Lowman | Nurse Practitioner | Citrus Primary Care Inc | 7648 S Florida Ave, Floral City, FL 34436-2738 |
| Aloysius T Bisong | Physician Assistant | Citrus Primary Care Inc | 7648 S Florida Ave, Floral City, FL 34436-2738 |
| Street Address |
10334 N CITRUS SPRINGS BLVD |
| City | CITRUS SPRINGS |
| State | FL |
| Zip | 34434-3217 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Alberto P Lorenzo | Internal Medicine | West Florida Medical Associates P A | 10489 N Florida Ave, Citrus Springs, FL 34434-3268 |
| Ravi K Koti | Hematology/oncology | Central Florida Cancer and Blood Center Pa | 10483 N Florida Ave, Citrus Springs, FL 34434-3268 |
| City | CITRUS SPRINGS |
| Zip Code | 34434 |
| Specialty | FAMILY PRACTICE |
| City + Specialty | CITRUS SPRINGS + FAMILY PRACTICE |
Please comment or provide details below to improve the information on Lydia V Wallace.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.