Basic Information
| Provider Information | |||||||||
| NPI: | 1679230684 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIMEDHEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4343 W NEWBERRY ROAD STE 18 ADMINISTRATION | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522242200 | ||||||||
| FaxNumber: | 3522242484 | ||||||||
| Practice Location | |||||||||
| Address1: | 4343 W NEWBERRY ROAD SUITE 13 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326072825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523327770 | ||||||||
| FaxNumber: | 3523322825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2021 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | DUNCANSON | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3522242302 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SIMEDHEALTH, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.