Provider Demographics
NPI:1699948133
Name:CENTRAL FLORIDA INTERNAL MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:CENTRAL FLORIDA INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:KORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-533-2850
Mailing Address - Street 1:2000 OSPREY BLVD
Mailing Address - Street 2:STE 109
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4347
Mailing Address - Country:US
Mailing Address - Phone:863-533-2850
Mailing Address - Fax:863-519-5616
Practice Address - Street 1:2000 OSPREY BLVD
Practice Address - Street 2:STE 109
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4347
Practice Address - Country:US
Practice Address - Phone:863-533-2850
Practice Address - Fax:863-519-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28191OtherBCBS OF FL
FL28191OtherBCBS OF FL
FLAA709Medicare PIN