Provider Demographics
NPI:1801122940
Name:FLORIDA HEALTH MANAGEMENT GROUP, INC
Entity type:Organization
Organization Name:FLORIDA HEALTH MANAGEMENT GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VIERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-331-2798
Mailing Address - Street 1:1920 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:503
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4722
Mailing Address - Country:US
Mailing Address - Phone:305-331-2798
Mailing Address - Fax:954-944-3181
Practice Address - Street 1:1920 E HALLANDALE BEACH BLVD
Practice Address - Street 2:503
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4722
Practice Address - Country:US
Practice Address - Phone:305-331-2798
Practice Address - Fax:954-944-3181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA HEALTH MANAGEMENT GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-25
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
FLPA 9103525363A00000X, 363AM0700X
FLME502772081P2900X, 208VP0014X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05653OtherMEDICARE ID-TYPE UNSPECIFIED
FL05653OtherMEDICARE ID-TYPE UNSPECIFIED