Basic Information
| Provider Information | |||||||||
| NPI: | 1033443262 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENET FLORIDA PHYSICIAN SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5810 CORAL RIDGE DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330763374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545093650 | ||||||||
| FaxNumber: | 9547967268 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 NW 82ND AVE | ||||||||
| Address2: | STE 502 | ||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331666658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055949333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2009 | ||||||||
| LastUpdateDate: | 09/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | J. | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP, OPS FINANCE & PMI, TENET | ||||||||
| AuthorizedOfficialTelephone: | 4698936960 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.