Provider Demographics
NPI:1033749155
Name:INTERNAL MEDICINE SPECIALISTS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE SPECIALISTS MEDICAL GROUP INC
Other - Org Name:RELIANCE MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-866-8014
Mailing Address - Street 1:4700 EXPLORATION AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-3319
Mailing Address - Country:US
Mailing Address - Phone:888-414-1413
Mailing Address - Fax:863-619-5995
Practice Address - Street 1:141 E CENTRAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-6319
Practice Address - Country:US
Practice Address - Phone:888-414-1413
Practice Address - Fax:863-619-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty