Provider Demographics
NPI:1922253962
Name:MID FLORIDA MEDICAL
Entity Type:Organization
Organization Name:MID FLORIDA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-422-2612
Mailing Address - Street 1:2800 SW 24TH AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7776
Mailing Address - Country:US
Mailing Address - Phone:352-237-1391
Mailing Address - Fax:352-629-5702
Practice Address - Street 1:2800 SW 24TH AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7776
Practice Address - Country:US
Practice Address - Phone:352-237-1391
Practice Address - Fax:352-629-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022645900Medicaid
FL022645900Medicaid