Provider Demographics
NPI:1154633873
Name:NORTH FLORIDA MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA MEDICAL GROUP, LLC
Other - Org Name:COASTAL URGENT CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RODMAN
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-867-7812
Mailing Address - Street 1:1702 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4290
Mailing Address - Country:US
Mailing Address - Phone:850-867-7812
Mailing Address - Fax:850-747-2016
Practice Address - Street 1:1702 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4290
Practice Address - Country:US
Practice Address - Phone:850-867-7812
Practice Address - Fax:850-747-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care