Provider Demographics
NPI:1417762519
Name:FLORIDA HOSPITAL MEDICAL GROUP INC
Entity type:Organization
Organization Name:FLORIDA HOSPITAL MEDICAL GROUP INC
Other - Org Name:
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:PO BOX 935933
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5933
Mailing Address - Country:US
Mailing Address - Phone:800-737-5654
Mailing Address - Fax:
Practice Address - Street 1:410 LIONEL WAY STE 201
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7809
Practice Address - Country:US
Practice Address - Phone:844-407-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier