Provider Demographics
NPI:1255477360
Name:HEALTHFLO MEDICAL CLINICS INC
Entity Type:Organization
Organization Name:HEALTHFLO MEDICAL CLINICS INC
Other - Org Name:BUSHNELL FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FIROZ
Authorized Official - Middle Name:
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-568-1988
Mailing Address - Street 1:117 W BELT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-5105
Mailing Address - Country:US
Mailing Address - Phone:352-568-1988
Mailing Address - Fax:352-568-2427
Practice Address - Street 1:117 W BELT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-5105
Practice Address - Country:US
Practice Address - Phone:352-568-1988
Practice Address - Fax:352-568-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066026261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38227AOtherBCBS
FL660062000Medicaid
FL38227AOtherBCBS
FLK0317AMedicare PIN