MEDICARE: FLORIDA PHYSICIANS MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1215980354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PHYSICIANS MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 538600
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32853-8600
Country	:	US
Telephone Number	:	407-200-2700
Fax Number	:	407-200-4904

Provider Business Practice Location Address
First Line	:	438 E VANN RD
Second Line	:	SUITE 200
City	:	GREENEVILLE
State	:	TN
Zip	:	37743-7202
Country	:	US
Telephone Number	:	423-278-1704
Fax Number	:	423-278-1832

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRYAN STILTZ
Credential	:
Telephone Number	:	407-200-2700

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	02/26/2010

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