Provider Demographics
NPI:1356583165
Name:REFLECTIONS OBGYN LLC
Entity type:Organization
Organization Name:REFLECTIONS OBGYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-610-8955
Mailing Address - Street 1:1705 BERGLUND LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6231
Mailing Address - Country:US
Mailing Address - Phone:321-610-8955
Mailing Address - Fax:321-610-8954
Practice Address - Street 1:1705 BERGLUND LN
Practice Address - Street 2:SUITE 102
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6231
Practice Address - Country:US
Practice Address - Phone:321-610-8955
Practice Address - Fax:321-610-8954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269307100Medicaid
FLI13260Medicare UPIN