Provider Demographics
NPI:1902012636
Name:MED-FLORIDA HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:MED-FLORIDA HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:LANG
Authorized Official - Last Name:GELETKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-359-9090
Mailing Address - Street 1:373 BRADEN AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2053
Mailing Address - Country:US
Mailing Address - Phone:941-359-9090
Mailing Address - Fax:941-360-1595
Practice Address - Street 1:373 BRADEN AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2053
Practice Address - Country:US
Practice Address - Phone:941-359-9090
Practice Address - Fax:941-360-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4592261QH0100X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM11477OtherMASSAGE ESTABLISHMENT LIC
FLHCC4592OtherHEALTH CARE CLINIC LICENS