Provider Demographics
NPI:1710107891
Name:FLORIDA MEDICAL PROVIDERS INC
Entity Type:Organization
Organization Name:FLORIDA MEDICAL PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:W CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-442-7881
Mailing Address - Street 1:2901 SW 149TH AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-442-7881
Mailing Address - Fax:954-442-9925
Practice Address - Street 1:2901 SW 149TH AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-442-7881
Practice Address - Fax:954-442-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care