Provider Demographics
NPI:1295033785
Name:VERIMED HEALTH GROUP SEMINOLE, LLC
Entity Type:Organization
Organization Name:VERIMED HEALTH GROUP SEMINOLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-577-0285
Mailing Address - Street 1:9555 SEMINOLE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2562
Mailing Address - Country:US
Mailing Address - Phone:727-319-8900
Mailing Address - Fax:727-319-8700
Practice Address - Street 1:9555 SEMINOLE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2562
Practice Address - Country:US
Practice Address - Phone:727-319-8900
Practice Address - Fax:727-319-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEW895AMedicare PIN