Provider Demographics
NPI:1033395397
Name:WELLMED MEDICAL MANAGEMENT OF FLORIDA INC
Entity Type:Organization
Organization Name:WELLMED MEDICAL MANAGEMENT OF FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-617-4706
Mailing Address - Street 1:19500 IH-10W, MS1-5030
Mailing Address - Street 2:ATTN: LICENSING & REGULATORY
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257
Mailing Address - Country:US
Mailing Address - Phone:210-617-4706
Mailing Address - Fax:
Practice Address - Street 1:549 NW LAKE WHITNEY PLACE
Practice Address - Street 2:BLDG I, SUITE 101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986
Practice Address - Country:US
Practice Address - Phone:210-617-4706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLMED MEDICAL MANAGEMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-17
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL603Medicare PIN