Provider Demographics
NPI:1700176013
Name:THE MEDICAL GROUP OF SOUTH FLORIDA INC
Entity Type:Organization
Organization Name:THE MEDICAL GROUP OF SOUTH FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-622-6111
Mailing Address - Street 1:PO BOX 743533
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3533
Mailing Address - Country:US
Mailing Address - Phone:561-622-1975
Mailing Address - Fax:855-830-1722
Practice Address - Street 1:4700 N CONGRESS AVE
Practice Address - Street 2:STE 103
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3282
Practice Address - Country:US
Practice Address - Phone:561-255-3131
Practice Address - Fax:855-346-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002251800Medicaid
FLK2513Medicare UPIN
FL002251800Medicaid