Lake Oliver Emergency Group, LLC
Organization Active NPI Emergency Medicine Physician · Tallahassee, FL
NPI 1013675016 · NPPES record last updated Sep 27, 2022
Key facts
- NPI
- 1013675016
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- LAKE OLIVER EMERGENCY GROUP, LLC
- Practice address
- 2626 Capital Medical Blvd
Tallahassee, FL 32308-4402 - Phone
- (850) 325-5000
- Fax
- (850) 656-5198
- NPI assigned
- Dec 7, 2021
- Organization subpart
- No
Authorized official
- Name
- Lisha C Falk
- Title
- VP of Contracting
- Phone
- (337) 609-1221
Other NPIs on the same Medicare enrollment 3
Practitioners 105
-
Dayanis Mercedes Acosta, D.O.
-
Andrew Omoh Agbi, D.O
-
Malvinder S Ajit, MD
-
Vesta Anilus, M.D.
-
Kiara Barnes, APRN, DNP, FNP-BC
-
Matthew William Berrios, D.O.
-
Tonya Amber Bolton, D.O.
-
Bruce D Burstein, M.D.
-
Stephen Michael Cremin, M.D.
-
Easa Darwish, APRN
-
Courtney Lane Davis, FNP-C, AGACNP-BC
-
Christopher Defreitas, M.D.
-
Joseph Duda, APRN
-
Derek L Eisnor, M.D.
-
Rachel Ann Elliott, ARNP
-
Aaron Cole Ford, APRN
-
Marianne Pinion Ford, APRN, FNP-BC, FNP-C
-
Charles Christopher Gerz, ARNP-C
-
Bethsaida Lopez Gillum, ARNP
-
James Monroe Harrison III, FNP-C
-
Lori Repp Harrison, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220413002299 | FL | Part B Supplier - Clinic/Group Practice | 4688060940 |
Receives reassigned benefits from 105 practitioners 3 other NPIs on this enrollment Practice locations: Tallahassee, FL; Quincy, FL |
National Provider Directory
Locations
3157 N Monroe St
Tallahassee, FL 32303
Phone (850) 325-5888
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes | ||
| Emergency Medical Services (Emergency Medicine) Physician |
207PE0004X | |||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
2626 Capital Medical Blvd
Tallahassee, FL 32308-4402
Mailing address
200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698
Other providers in Tallahassee, FL
- Evan Lahtinen
- Christopher Austin Laing
- Rhonda Rose Laing
- Katherine Elizabeth Lajeunesse
- Lake Ella Pharmacy
- Lake Oliver Emergency Group, LLC
- Lake Oliver Emergency Group, LLC
- Gurusami M. Lakshmin
- Saanvi Lalwani
- Vicki Lyn Lamare
All providers in Tallahassee, FL · Emergency Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.