Provider Demographics
NPI:1336471457
Name:MEDICAL PROVIDERS OF SOUTH FLORIDA, INC.
Entity Type:Organization
Organization Name:MEDICAL PROVIDERS OF SOUTH FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-862-1762
Mailing Address - Street 1:12401 ORANGE DR
Mailing Address - Street 2:SUITE 132
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4341
Mailing Address - Country:US
Mailing Address - Phone:954-862-1762
Mailing Address - Fax:
Practice Address - Street 1:12401 ORANGE DR
Practice Address - Street 2:SUITE 132
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4341
Practice Address - Country:US
Practice Address - Phone:954-862-1762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center