Provider Demographics
NPI:1124267398
Name:PDT OF OCALA, FL INC.
Entity type:Organization
Organization Name:PDT OF OCALA, FL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DODDS
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:352-207-5458
Mailing Address - Street 1:101 TEAK RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-8759
Mailing Address - Country:US
Mailing Address - Phone:352-207-5458
Mailing Address - Fax:866-330-7299
Practice Address - Street 1:101 TEAK RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-8759
Practice Address - Country:US
Practice Address - Phone:352-207-5458
Practice Address - Fax:866-330-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEQ327Medicare PIN