Provider Demographics
NPI:1669443156
Name:CMS FT. PIERCE
Entity Type:Organization
Organization Name:CMS FT. PIERCE
Other - Org Name:FLORIDA DEPARTMENT OF HEALTH-CHILDREN'S MEDICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-467-6008
Mailing Address - Street 1:1701 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4804
Mailing Address - Country:US
Mailing Address - Phone:772-467-6000
Mailing Address - Fax:772-467-6092
Practice Address - Street 1:1701 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4804
Practice Address - Country:US
Practice Address - Phone:772-467-6000
Practice Address - Fax:772-467-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLN/A GOVERNMENT AGENC251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare