Provider Demographics
NPI:1720275449
Name:FRANCIS X CONIDI DO MS PA
Entity Type:Organization
Organization Name:FRANCIS X CONIDI DO MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:X
Authorized Official - Last Name:CONIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-337-7272
Mailing Address - Street 1:10377 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5630
Mailing Address - Country:US
Mailing Address - Phone:772-337-7272
Mailing Address - Fax:772-337-7734
Practice Address - Street 1:10377 S US HIGHWAY 1
Practice Address - Street 2:SUITE 104
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5630
Practice Address - Country:US
Practice Address - Phone:772-337-7272
Practice Address - Fax:772-337-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7863261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF579Medicare PIN