Provider Demographics
NPI:1073515623
Name:SPRINGS FAMILY MEDICAL CENTER,PA
Entity Type:Organization
Organization Name:SPRINGS FAMILY MEDICAL CENTER,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRIJBAG
Authorized Official - Suffix:
Authorized Official - Credentials:CMMCPC,CCP,CSMCS
Authorized Official - Phone:352-597-1960
Mailing Address - Street 1:10200 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34613-8375
Mailing Address - Country:US
Mailing Address - Phone:352-597-1960
Mailing Address - Fax:352-597-9470
Practice Address - Street 1:10200 YALE AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34613-8375
Practice Address - Country:US
Practice Address - Phone:352-597-1960
Practice Address - Fax:352-597-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOSOO6159207Q00000X
FLOS006150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253212300Medicaid
FLCL7567OtherTRAVELERS MEDICARE GROUP
FL253212300Medicaid