Provider Demographics
NPI:1124583166
Name:FLORIDA INJURY MEDICAL CENTERS
Entity Type:Organization
Organization Name:FLORIDA INJURY MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-742-7312
Mailing Address - Street 1:432 N PINE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2306
Mailing Address - Country:US
Mailing Address - Phone:386-742-7312
Mailing Address - Fax:
Practice Address - Street 1:432 N PINE MEADOW DR
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2306
Practice Address - Country:US
Practice Address - Phone:386-742-7312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center