Provider Demographics
NPI:1912938648
Name:FLORIDA DRX, LLC
Entity Type:Organization
Organization Name:FLORIDA DRX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:NADEEM
Authorized Official - Last Name:HASHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-527-6699
Mailing Address - Street 1:70 N LECANTO HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9190
Mailing Address - Country:US
Mailing Address - Phone:352-527-6699
Mailing Address - Fax:352-527-0720
Practice Address - Street 1:520 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8547
Practice Address - Country:US
Practice Address - Phone:352-527-9444
Practice Address - Fax:352-746-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8010Medicare ID - Type UnspecifiedMEDICARE PROV ID