Provider Demographics
NPI:1487769576
Name:THE EHS MEDICAL PRACTICE PA
Entity type:Organization
Organization Name:THE EHS MEDICAL PRACTICE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:352-331-5100
Mailing Address - Street 1:529 NE 60TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2008
Mailing Address - Country:US
Mailing Address - Phone:352-331-5100
Mailing Address - Fax:
Practice Address - Street 1:529 NE 60TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2008
Practice Address - Country:US
Practice Address - Phone:352-331-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 161274174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34968OtherBLUE CROSS / BLUE SHIELD
FL34968Medicare PIN