Healthcare Provider Details

I. General information

NPI: 1376877514
Provider Name (Legal Business Name): TENET FLORIDA PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6175 NW 153RD ST STE 225
HIALEAH FL
33014-2435
US

IV. Provider business mailing address

5810 CORAL RIDGE DR STE 300
CORAL SPRINGS FL
33076-3374
US

V. Phone/Fax

Practice location:
  • Phone: 305-698-6292
  • Fax:
Mailing address:
  • Phone: 954-509-3650
  • Fax: 954-796-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. J. SCOTT RICHARDSON
Title or Position: SVP, OPS FINANCE & PMI, TENET
Credential:
Phone: 469-893-6960