Provider Demographics
NPI:1033881180
Name:INDEPENDENT MEDICAL GROUP, LLC.
Entity Type:Organization
Organization Name:INDEPENDENT MEDICAL GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - PROJECT MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-505-6435
Mailing Address - Street 1:5701 NW 88TH AVE STE 390
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4451
Mailing Address - Country:US
Mailing Address - Phone:800-773-7066
Mailing Address - Fax:833-258-4230
Practice Address - Street 1:7436 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1417
Practice Address - Country:US
Practice Address - Phone:800-773-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENT MEDICAL GROUP, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-28
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health