Provider Demographics
NPI:1972671527
Name:FLORIDA SPORTS AND FAMILY HEALTH CENTER PA
Entity Type:Organization
Organization Name:FLORIDA SPORTS AND FAMILY HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-935-1192
Mailing Address - Street 1:309 W BASS ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5011
Mailing Address - Country:US
Mailing Address - Phone:407-935-1192
Mailing Address - Fax:407-935-9386
Practice Address - Street 1:309 W BASS ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5011
Practice Address - Country:US
Practice Address - Phone:407-935-1192
Practice Address - Fax:407-935-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ60419Medicare UPIN
FLE64804Medicare UPIN