Nature Coast Mind Body Medicine, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NATURE COAST MIND BODY MEDICINE, LLC

Practice address

210 S Salisbury Ter
Lecanto, FL 34461-5104

Phone

(352) 631-7460

NPI assigned

Jul 2, 2018

Last updated

Jan 4, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Eilis Clark, MDNPI 1073621215

Title

MGRM

Phone

(352) 631-7460

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eilis Clark, MD

  • Psychiatry Physician
  • Roanoke Rapids, NC
  • NPI 1073621215
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578096000000",
    "number": "1255827226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S SALISBURY TER",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344615104",
            "telephone_number": "352-631-7460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S SALISBURY TER",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344615104",
            "telephone_number": "352-631-7460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATURE COAST MIND BODY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-02",
        "last_updated": "2020-01-04",
        "certification_date": "2020-01-04",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EILIS",
        "authorized_official_title_or_position": "MGRM",
        "authorized_official_telephone_number": "352-631-7460",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Ashley Najimian, OTR/L
• National Mentor Healthcare LLC (Florida Mentor)
• National Vision, Inc (America's Best Contacts & Eyeglasses)
• Nature Coast Emergency Medical Foundation Inc (Nature Coast EMS)
• Nature Coast Lodge, LLP (Nature Coast)
• Nature Coast Pathology Services, Inc.
• Nature Coast Pediatrics, Inc
• Nature Coast Psychiatry PLLC (Dr Eilis Clark MD)
• Naturecoast Pain Associates Inc (Gentle Anesthesia Specialists)
• Naturecoast Pain Associates Inc

• Family Medicine Physician in Lecanto, FL
• Providers in Lecanto, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.