Organization Active NPI

Mini Health Clinic, LLC

  • Primary Care Clinic/Center
  • Clermont, FL
National Provider Identifier
1770179590
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MINI HEALTH CLINIC, LLC
Practice address
1150 Anderson St
Clermont, FL 34711-2507
Phone
(352) 227-3000
Fax
(352) 505-7738
NPI assigned
Dec 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

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

Authorized official

Name
Mrs. Kemeisha T Morgan, APRNNPI 1417403510
Title
Owner/Provider
Phone
(352) 227-3000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083B0002X
Primary Care Clinic/Center 261QP2300X Primary
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

1150 Anderson St
Clermont, FL 34711-2507

Mailing address

1028 Glenraven LN
Clermont, FL 34711-9008
Phone (407) 733-3923

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250515003343 FL Part B Supplier - Clinic/Group Practice 3476071127 Receives reassigned benefits from 1 practitioner
Practice locations: Clermont, FL

National Provider Directory

National Provider Directory

Locations

1150 Anderson St
Clermont, FL 34711
Phone (352) 227-3000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1608076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1770179590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 GLENRAVEN LN",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347119008",
            "telephone_number": "407-733-3923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 ANDERSON ST",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112507",
            "telephone_number": "352-227-3000",
            "fax_number": "352-505-7738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINI HEALTH CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-16",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "MORGAN",
        "authorized_official_first_name": "KEMEISHA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "352-227-3000",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "2083B0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.