Healthcare Provider Details

I. General information

NPI: 1760778617
Provider Name (Legal Business Name): FLORIDA EMERGENCY CONSULTANTS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W SAGAMORE AVE
CLEWISTON FL
33440-3514
US

IV. Provider business mailing address

75 REMIT DR # 1367
CHICAGO IL
60675-1367
US

V. Phone/Fax

Practice location:
  • Phone: 863-983-9121
  • Fax: 863-983-1809
Mailing address:
  • Phone: 800-701-3381
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DERIK K KING
Title or Position: LLP MANAGING PARTNER
Credential: MD
Phone: 800-701-3381