Provider Demographics
NPI:1053667972
Name:FLORENCE FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:FLORENCE FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-891-8134
Mailing Address - Street 1:3091 HIGHWAY 49 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9452
Mailing Address - Country:US
Mailing Address - Phone:601-891-8134
Mailing Address - Fax:601-891-8364
Practice Address - Street 1:3091 HIGHWAY 49 S
Practice Address - Street 2:SUITE B
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9452
Practice Address - Country:US
Practice Address - Phone:601-891-8134
Practice Address - Fax:601-891-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-29
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty