Provider Demographics
NPI:1083205231
Name:INDEPENDENT MEDICAL GROUP, LLC.
Entity Type:Organization
Organization Name:INDEPENDENT MEDICAL GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS MANAGER
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 1:4101 S HOSPITAL DRIVE SUITE 2
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:407-314-7492
Mailing Address - Fax:833-253-4230
Practice Address - Street 1:4101 S HOSPITAL DRIVE SUITE 2
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:407-314-7492
Practice Address - Fax:833-253-4230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMG PLANTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-31
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service