Healthcare Provider Details

I. General information

NPI: 1225179450
Provider Name (Legal Business Name): THE MEDICAL GROUP OF SOUTH FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 MILITARY TRL
JUPITER FL
33458-7021
US

IV. Provider business mailing address

1094 MILITARY TRL
JUPITER FL
33458-7021
US

V. Phone/Fax

Practice location:
  • Phone: 561-622-6111
  • Fax: 561-622-1176
Mailing address:
  • Phone: 561-622-6111
  • Fax: 855-215-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA K SMITH
Title or Position: OWNER
Credential: DC
Phone: 561-622-6111