Provider Demographics
NPI:1942270905
Name:E & M MEDICAL SERVICES
Entity type:Organization
Organization Name:E & M MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:INNOCENT-SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-468-1735
Mailing Address - Street 1:10383 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-7843
Mailing Address - Country:US
Mailing Address - Phone:352-468-1735
Mailing Address - Fax:352-468-1739
Practice Address - Street 1:10383 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-7843
Practice Address - Country:US
Practice Address - Phone:352-468-1735
Practice Address - Fax:352-468-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57355OtherBCBS
FL250170800Medicaid
FL=========OtherTAX ID
FL=========OtherTAX ID
FL57355OtherBCBS
FL57355SMedicare ID - Type UnspecifiedMEDICARE