Healthcare Provider Details

I. General information

NPI: 1851912943
Provider Name (Legal Business Name): EP CRITICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 N FEDERAL HWY
FT LAUDERDALE FL
33308-4603
US

IV. Provider business mailing address

PO BOX 24847
JACKSONVILLE FL
32241-4847
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK CAPUTO
Title or Position: PRESIDENT
Credential: MD
Phone: 918-527-7024