Provider Demographics
NPI:1245474238
Name:GREMA MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:GREMA MEDICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN MARIE
Authorized Official - Middle Name:GREGOIRE
Authorized Official - Last Name:EUGENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-873-5213
Mailing Address - Street 1:1362 SW BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:772-873-5213
Mailing Address - Fax:772-873-5215
Practice Address - Street 1:1362 SW BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:772-873-5213
Practice Address - Fax:772-873-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043064261Q00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE12078OtherUPIN