Healthcare Provider Details

I. General information

NPI: 1134495351
Provider Name (Legal Business Name): FLORIDA EM-I MEDICAL SERVICES, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W SEMINOLE BLVD
SANFORD FL
32771-6743
US

IV. Provider business mailing address

PO BOX 37870
PHILADELPHIA PA
19101-0170
US

V. Phone/Fax

Practice location:
  • Phone: 407-321-4500
  • Fax:
Mailing address:
  • Phone: 800-355-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. TERRY R. MEADOWS
Title or Position: VICE PRESIDENT FLORIDA EM-MEDICAL S
Credential: M.D.
Phone: 800-507-8874