Provider Demographics
NPI:1164568275
Name:HEALTHFLO MEDICAL CLINICS INC
Entity Type:Organization
Organization Name:HEALTHFLO MEDICAL CLINICS INC
Other - Org Name:RIDGE MANOR MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-568-1988
Mailing Address - Street 1:34498 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGE MANOR
Mailing Address - State:FL
Mailing Address - Zip Code:33523-8908
Mailing Address - Country:US
Mailing Address - Phone:352-583-4520
Mailing Address - Fax:352-583-5527
Practice Address - Street 1:34498 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:RIDGE MANOR
Practice Address - State:FL
Practice Address - Zip Code:33523-8908
Practice Address - Country:US
Practice Address - Phone:352-583-4520
Practice Address - Fax:352-583-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066026261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38227AOtherBCBS
FL255718500Medicaid
FL255718500Medicaid
FL103804Medicare Oscar/Certification
FL38227AOtherBCBS