Healthcare Provider Details

I. General information

NPI: 1528242906
Provider Name (Legal Business Name): FLORIDA NEUROLOGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 SW 19TH AVENUE RD SUITE 101
OCALA FL
34471-7751
US

IV. Provider business mailing address

2237 SW 19TH AVE RD SUITE 101
OCALA FL
34471-6505
US

V. Phone/Fax

Practice location:
  • Phone: 352-867-9877
  • Fax: 352-867-1040
Mailing address:
  • Phone: 352-867-9877
  • Fax: 352-867-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOS7448
License Number StateFL

VIII. Authorized Official

Name: DR. LANCE Y KIM
Title or Position: PRESIDENT
Credential: D.O.
Phone: 352-867-9877