Healthcare Provider Details

I. General information

NPI: 1225034234
Provider Name (Legal Business Name): FLORIDA HOSPITAL MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 E RIDGEWOOD ST
ORLANDO FL
32803-5443
US

IV. Provider business mailing address

2600 WESTHALL LN STE 4
MAITLAND FL
32751-7102
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-1100
  • Fax: 407-843-7983
Mailing address:
  • Phone: 407-200-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberNA
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberNA
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNA
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNA
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberNA
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberNA
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNA
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNA
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberNA
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberNA
License Number StateFL
# 12
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberNA
License Number StateFL
# 13
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberNA
License Number StateFL
# 14
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberNA
License Number StateFL
# 15
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNA
License Number StateFL

VIII. Authorized Official

Name: MR. VANCE ALAN MCLARREN II
Title or Position: CEO
Credential:
Phone: 407-200-2700