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NPI Code Detail

MEDICARE: SOUTHERN MEDICAL SERVICES GROUP,INC.

MEDICARE: SOUTHERN MEDICAL SERVICES 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
12084P0805XGeriatric Psychiatry PhysicianME36479FL

General Provider Information

NPI Number : 1881892073
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN MEDICAL SERVICES GROUP,INC.
Provider Business Mailing Address
First Line : 3342 NE 34TH ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-6906
Country : US
Telephone Number : 954-583-7267
Fax Number : 954-583-0535
Provider Business Practice Location Address
First Line : 3342 NE 34TH ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-6906
Country : US
Telephone Number : 954-583-7267
Fax Number : 954-583-0535
Authorized Official
Title or Position : OFFICE MANAGER
Name : MISS PRITI M SHAH
Credential :
Telephone Number : 954-583-7267
Provider Enumeration Date : 07/10/2007
Last Update Date : 10/09/2014

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Directions to “SOUTHERN MEDICAL SERVICES GROUP,INC. ” Practice Location

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