Healthcare Provider Details

I. General information

NPI: 1316127988
Provider Name (Legal Business Name): FLORIDA NEUROLIGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 SW 1ST AVE
OCALA FL
34471-6505
US

IV. Provider business mailing address

1503 SW 1ST AVE
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 TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberOS7448
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberOS7448
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberOS7448
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS7448
License Number StateFL

VIII. Authorized Official

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