Provider Demographics
NPI:1629565932
Name:MID FLORIDA PHYSICIANS GROUP INC.
Entity Type:Organization
Organization Name:MID FLORIDA PHYSICIANS GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:ECKLIND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-290-6721
Mailing Address - Street 1:300 S MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-4542
Mailing Address - Country:US
Mailing Address - Phone:352-643-6699
Mailing Address - Fax:888-643-6699
Practice Address - Street 1:300 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-4542
Practice Address - Country:US
Practice Address - Phone:352-643-6699
Practice Address - Fax:888-675-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty