Provider Demographics
NPI:1083905178
Name:RECOVERY ROOM- IMMEDIATE CARE
Entity Type:Organization
Organization Name:RECOVERY ROOM- IMMEDIATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-863-3000
Mailing Address - Street 1:2010 LEWIS TURNER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1352
Mailing Address - Country:US
Mailing Address - Phone:850-863-3000
Mailing Address - Fax:850-862-1621
Practice Address - Street 1:2010 LEWIS TURNER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1352
Practice Address - Country:US
Practice Address - Phone:850-863-3000
Practice Address - Fax:850-863-3000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NW FL LUNG ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-25
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252347700Medicaid