Provider Demographics
NPI:1619221637
Name:FLORIDA PHYSICIAN SPECIALISTS LLC
Entity Type:Organization
Organization Name:FLORIDA PHYSICIAN SPECIALISTS LLC
Other - Org Name:MCIVER UROLOGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TERK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-309-8680
Mailing Address - Street 1:710 LOMAX ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4004
Mailing Address - Country:US
Mailing Address - Phone:904-355-6584
Mailing Address - Fax:904-355-4922
Practice Address - Street 1:710 LOMAX ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4004
Practice Address - Country:US
Practice Address - Phone:904-355-6584
Practice Address - Fax:904-355-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty