Healthcare Provider Details

I. General information

NPI: 1669845640
Provider Name (Legal Business Name): MARTIN COUNTY PHYSICIANS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 SW MARTIN DOWNS BLVD
PALM CITY FL
34990-2644
US

IV. Provider business mailing address

3003 SW MARTIN DOWNS BLVD
PALM CITY FL
34990-2644
US

V. Phone/Fax

Practice location:
  • Phone: 772-617-0126
  • Fax:
Mailing address:
  • Phone: 772-219-1355
  • Fax: 772-223-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINA TUCKER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 772-219-1355