Provider Demographics
NPI:1801487053
Name:INDEPENDENT MEDICAL GROUP, LLC.
Entity type:Organization
Organization Name:INDEPENDENT MEDICAL GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-505-6435
Mailing Address - Street 1:3880 COCONUT CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1643
Mailing Address - Country:US
Mailing Address - Phone:407-314-7492
Mailing Address - Fax:833-258-4230
Practice Address - Street 1:3880 COCONUT CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1643
Practice Address - Country:US
Practice Address - Phone:407-314-7492
Practice Address - Fax:833-258-4230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENT MEDICAL GROUP, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-31
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service