Provider Demographics
NPI:1417635921
Name:LIFEMD SOUTHERN PATIENT MEDICAL CARE PC
Entity Type:Organization
Organization Name:LIFEMD SOUTHERN PATIENT MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:YECIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-852-1575
Mailing Address - Street 1:236 5TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7606
Mailing Address - Country:US
Mailing Address - Phone:800-852-1575
Mailing Address - Fax:
Practice Address - Street 1:1200 SOUTH PINE ROAD, SUITE 250 PLANTATION, FL 33324
Practice Address - Street 2:SUITE 250
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:800-852-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty