Provider Demographics
NPI:1437152543
Name:MEDFUND LLC
Entity Type:Organization
Organization Name:MEDFUND LLC
Other - Org Name:HORIZON PLANTATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-925-3490
Mailing Address - Street 1:240 N WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5945
Mailing Address - Country:US
Mailing Address - Phone:941-925-3490
Mailing Address - Fax:941-953-4452
Practice Address - Street 1:150 N UNIVERSITY DR
Practice Address - Street 2:STE 110
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2004
Practice Address - Country:US
Practice Address - Phone:954-423-3674
Practice Address - Fax:954-916-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5202261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL470001847OtherRR MCARE
FLV2652OtherBCBS PROVIDER #
470001841OtherRAILROAD MCARE #
FL105715-19OtherCITRUS HMO
103905414OtherDEPT OF LABOR/ACS
FLV2652OtherBCBS PROVIDER #