Provider Demographics
NPI:1427228998
Name:FAMILY MEDICAL SPECIALISTS OF FLORIDA PLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL SPECIALISTS OF FLORIDA PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIMNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-567-5679
Mailing Address - Street 1:1703 THONOTOSASSA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4202
Mailing Address - Country:US
Mailing Address - Phone:813-567-5679
Mailing Address - Fax:813-567-5686
Practice Address - Street 1:1703 THONOTOSASSA RD
Practice Address - Street 2:SUITE A
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4202
Practice Address - Country:US
Practice Address - Phone:813-567-5679
Practice Address - Fax:813-567-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274338800Medicaid
FLI45886Medicare UPIN