Provider Demographics
NPI:1205807914
Name:FRIDLEY ROEMER HCS, INC.
Entity type:Organization
Organization Name:FRIDLEY ROEMER HCS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD NP-C
Authorized Official - Phone:850-896-1387
Mailing Address - Street 1:644 FLORIDA AVE
Mailing Address - Street 2:UNIT E
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-6355
Mailing Address - Country:US
Mailing Address - Phone:850-896-1387
Mailing Address - Fax:
Practice Address - Street 1:644 FLORIDA AVE
Practice Address - Street 2:UNIT E
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-6355
Practice Address - Country:US
Practice Address - Phone:850-896-1387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNP1376612261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1376612OtherMSC. IDENTIFIER STATE LIC
NMR49453OtherSTATE LICENSE #
FLY6683OtherBLUE CROSS BLUE SHIELD
FL00200184549Medicaid
FLTRICARE STANDARDOther
FLS69570Medicare UPIN