Provider Demographics
NPI:1942729736
Name:CKMT ENTERPRISES, LLC
Entity Type:Organization
Organization Name:CKMT ENTERPRISES, LLC
Other - Org Name:TMS OF CENTRAL FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DURWOOD
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-924-2389
Mailing Address - Street 1:1119 NIKKI VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4879
Mailing Address - Country:US
Mailing Address - Phone:813-657-7022
Mailing Address - Fax:813-657-1049
Practice Address - Street 1:1119 NIKKI VIEW DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4879
Practice Address - Country:US
Practice Address - Phone:813-657-7022
Practice Address - Fax:813-657-1049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TMS OF CENTRAL FLORIDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00725372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty