Provider Demographics
NPI:1629345681
Name:MEDICAL & INJURY CENTERS OF FLORIDA
Entity Type:Organization
Organization Name:MEDICAL & INJURY CENTERS OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-938-2625
Mailing Address - Street 1:800 VIRGINIA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-4302
Mailing Address - Country:US
Mailing Address - Phone:770-938-2625
Mailing Address - Fax:404-549-3393
Practice Address - Street 1:5132 US HIGHWAY 19
Practice Address - Street 2:21ST CENTURY PAVILLION
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3942
Practice Address - Country:US
Practice Address - Phone:727-807-7932
Practice Address - Fax:727-807-7939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTA PHYSICIANS GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-18
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty