Ultimate Medical Clinic LLC
Organization Active NPI Primary Care Clinic/Center · Debary, FL
NPI 1922692003 · NPPES record last updated Mar 1, 2021
Key facts
- NPI
- 1922692003
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- ULTIMATE MEDICAL CLINIC LLC
- Practice address
- 70 Fox Ridge CT Ste a
Debary, FL 32713-2752 - Phone
- (386) 668-6321
- NPI assigned
- Mar 1, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- DEBARY CHIROPRACTIC CENTER CORP
Authorized official
- Name
- Jamie Grainger, DC
- Title
- Owner/Chiropractor
- Phone
- (386) 668-6321
Parent organization (reported in NPPES) 1
Member of 1
Practitioners 4
-
Jennifer Kaufmann, APRN
-
Meganne Mannon, ARNP
-
Lauren Anne Eggnatz, APRN
-
Jamie Grainger, D.C.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2224663 | Ultimate Medical Clinic | Certificate of waiver | May 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210427002022 | FL | Part B Supplier - Clinic/Group Practice | 4486062684 |
Receives reassigned benefits from 2 practitioners Practice locations: Debary, FL |
National Provider Directory
- Part of
- Debary Chiropractic Center Corp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
70 Fox Ridge CT Ste a
Debary, FL 32713-2752
Mailing address
70 Fox Ridge CT Ste a
Debary, FL 32713-2752
Phone (386) 668-6321
Other providers in Debary, FL
- Together in Health, Inc
- Total Vision PA
- Anthony Joseph Tucker
- Rebecca Jane Tulloch
- Orly Tyrkala
- Rosendo De Jesus Urena
- Wanda Kay Vasquez
- Nicole Teresa Velazquez
- Aimee Elizabeth Velez
- Carmen Adela Viera
All providers in Debary, FL · Primary Care Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2021. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.