Provider Demographics
NPI:1699018127
Name:FLA MEDICAL PAIN RELIEF & DETOX CENTER LLC
Entity Type:Organization
Organization Name:FLA MEDICAL PAIN RELIEF & DETOX CENTER LLC
Other - Org Name:FLORIDA MEDICAL HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-966-7911
Mailing Address - Street 1:6740 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3903
Mailing Address - Country:US
Mailing Address - Phone:954-966-7911
Mailing Address - Fax:954-966-3352
Practice Address - Street 1:6740 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3903
Practice Address - Country:US
Practice Address - Phone:954-966-7911
Practice Address - Fax:954-966-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty