Provider Demographics
NPI: | 1750626495 |
---|---|
Name: | HEALTH FIRST MEDICAL GROUP, LLC |
Entity type: | Organization |
Organization Name: | HEALTH FIRST MEDICAL GROUP, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VP REVENUE OPERATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHAUN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RONAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 321-434-5482 |
Mailing Address - Street 1: | 3300 S FISKE BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | ROCKLEDGE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32955-4306 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 321-434-1981 |
Mailing Address - Fax: | 321-434-5485 |
Practice Address - Street 1: | 1223 GATEWAY DR |
Practice Address - Street 2: | |
Practice Address - City: | MELBOURNE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32901-2607 |
Practice Address - Country: | US |
Practice Address - Phone: | 321-434-5055 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | HEALTH FIRST PHYSICIANS, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2012-12-06 |
Last Update Date: | 2025-02-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 008009000 | Medicaid | |
FL | 003XF | Other | FLORIDA BLUE GROUP # |
FL | 008009000 | Medicaid |