1225034234 NPI number — FLORIDA HOSPITAL MEDICAL GROUP INC

Table of content: (NPI 1225034234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225034234 NPI number — FLORIDA HOSPITAL MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA HOSPITAL MEDICAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225034234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 WESTHALL LN FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751-7102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-200-2700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 WESTHALL LN FL 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAITLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32751-7102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-200-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCLARREN
Authorized Official First Name:
VANCE
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
407-200-2700

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204F00000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208C00000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 252226801 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226811 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226806 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226809 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226814 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226818 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226802 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226808 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226810 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226812 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226813 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226805 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252226807 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24567 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 252226804 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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