MEDICARE: FLORIDA MEDICAL SPECIALISTS, LLC

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	208D00000X	General Practice Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1285399857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MEDICAL SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 25487
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34277-2487
Country	:	US
Telephone Number	:	941-259-0926
Fax Number	:	855-253-4836

Provider Business Practice Location Address
First Line	:	405 S 11TH ST
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33853-4202
Country	:	US
Telephone Number	:	863-679-8000
Fax Number	:	863-679-2694

Authorized Official
Title or Position	:	SENIOR VP OF CLINICAL OPERATIONS
Name	:	INITA BEDI
Credential	:
Telephone Number	:	941-202-5338

Provider Enumeration Date	:	11/08/2021
Last Update Date	:	11/08/2021

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