Provider Demographics
NPI:1932680469
Name:FLORIDA PHYSICIAN SPECIALISTS LLC
Entity type:Organization
Organization Name:FLORIDA PHYSICIAN SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MEAGHAN
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-520-6800
Mailing Address - Street 1:7017 A C SKINNER PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-520-6800
Mailing Address - Fax:904-520-6801
Practice Address - Street 1:1860 TOWN HALL CIR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4331
Practice Address - Country:US
Practice Address - Phone:904-520-6800
Practice Address - Fax:904-520-6801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA PHYSICIAN SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-23
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty