Provider Demographics
NPI:1376807610
Name:LINCARE PULMONARY REHAB SERVICES OF FLORIDA, PL
Entity Type:Organization
Organization Name:LINCARE PULMONARY REHAB SERVICES OF FLORIDA, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-431-8273
Mailing Address - Street 1:19387 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-3102
Mailing Address - Country:US
Mailing Address - Phone:727-431-8261
Mailing Address - Fax:877-524-9504
Practice Address - Street 1:823 DUNLAWTON AVE STE A
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4221
Practice Address - Country:US
Practice Address - Phone:386-322-4552
Practice Address - Fax:386-322-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFC718COtherPTAN