Provider Demographics
NPI:1972314300
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 STE 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 1:604 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4198
Practice Address - Country:US
Practice Address - Phone:407-846-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty