Provider Demographics
NPI:1346581824
Name:EDEMA SPECIALISTS OF SOUTH FLORIDA, INC
Entity Type:Organization
Organization Name:EDEMA SPECIALISTS OF SOUTH FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-907-0826
Mailing Address - Street 1:702 SE 2ND AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5444
Mailing Address - Country:US
Mailing Address - Phone:954-907-0826
Mailing Address - Fax:561-300-2156
Practice Address - Street 1:702 SE 2ND AVE APT 404
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5444
Practice Address - Country:US
Practice Address - Phone:954-907-0826
Practice Address - Fax:561-300-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5972261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHD068AMedicare UPIN
FLHD068AMedicare UPIN
FL887876500Medicaid