Provider Demographics
NPI:1154781284
Name:VERIMED HEALTH GROUP LAND O' LAKES, LLC
Entity type:Organization
Organization Name:VERIMED HEALTH GROUP LAND O' LAKES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:ADM
Authorized Official - Phone:813-909-0760
Mailing Address - Street 1:2638 NARNIA WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7231
Mailing Address - Country:US
Mailing Address - Phone:813-909-0760
Mailing Address - Fax:813-949-7394
Practice Address - Street 1:2638 NARNIA WAY
Practice Address - Street 2:STE 101
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7231
Practice Address - Country:US
Practice Address - Phone:813-909-0760
Practice Address - Fax:813-949-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty