Provider Demographics
NPI:1225034234
Name:FLORIDA HOSPITAL MEDICAL GROUP INC
Entity type:Organization
Organization Name:FLORIDA HOSPITAL MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MCLARREN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:407-200-2700
Mailing Address - Street 1:2600 WESTHALL LN FL 4
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7102
Mailing Address - Country:US
Mailing Address - Phone:407-200-2700
Mailing Address - Fax:
Practice Address - Street 1:2600 WESTHALL LN FL 4
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7102
Practice Address - Country:US
Practice Address - Phone:407-200-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNA103G00000X, 204F00000X, 207Q00000X, 207R00000X, 207V00000X, 207X00000X, 208000000X, 2084P0800X, 208600000X, 208C00000X, 208D00000X, 208M00000X, 363A00000X, 363L00000X
207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252226801Medicaid
FL252226811Medicaid
FL252226806Medicaid
FL252226809Medicaid
FL252226814Medicaid
FL252226818Medicaid
FL252226802Medicaid
FL252226808Medicaid
FL252226810Medicaid
FL252226812Medicaid
FL252226813Medicaid
FL252226800Medicaid
FL252226805Medicaid
FL252226807Medicaid
FL24567OtherBCBS FL
FL252226804Medicaid
FL252226813Medicaid
FL252226805Medicaid
FL252226806Medicaid
FL40811Medicare PIN