Provider Demographics
NPI:1013687177
Name:FIREMED OF SOUTHEAST, LLC
Entity Type:Organization
Organization Name:FIREMED OF SOUTHEAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:IMMUNIZATION SPECIAL
Authorized Official - Phone:978-230-9668
Mailing Address - Street 1:2479 TRIANNA STREET
Mailing Address - Street 2:FIREMED SOUTHEAST
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34291
Mailing Address - Country:US
Mailing Address - Phone:941-899-1430
Mailing Address - Fax:
Practice Address - Street 1:2479 TRIANNA STREET
Practice Address - Street 2:FIREMED SOUTHEAST
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34291
Practice Address - Country:US
Practice Address - Phone:941-899-1430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory ImmunologyGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No305S00000XManaged Care OrganizationsPoint of Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty