Provider Demographics
NPI:1194311407
Name:VERIMED HEALTH GROUP BROOKSVILLE LLC
Entity type:Organization
Organization Name:VERIMED HEALTH GROUP BROOKSVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-469-6334
Mailing Address - Street 1:932 CANDLELIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3116
Mailing Address - Country:US
Mailing Address - Phone:352-345-8185
Mailing Address - Fax:352-345-8073
Practice Address - Street 1:932 CANDLELIGHT BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3116
Practice Address - Country:US
Practice Address - Phone:352-345-8185
Practice Address - Fax:352-345-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty