Provider Demographics
NPI:1871073122
Name:SICKNWELL LLC
Entity type:Organization
Organization Name:SICKNWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DACELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-527-6888
Mailing Address - Street 1:PO BOX 2066
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460-2066
Mailing Address - Country:US
Mailing Address - Phone:352-563-0931
Mailing Address - Fax:352-563-0931
Practice Address - Street 1:1990 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9792
Practice Address - Country:US
Practice Address - Phone:352-527-6888
Practice Address - Fax:352-527-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty