Healthcare Provider Details

I. General information

NPI: 1518291509
Provider Name (Legal Business Name): TENET FLORIDA PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CENTURY BLVD
WEST PALM BEACH FL
33417-2262
US

IV. Provider business mailing address

5810 CORAL RIDGE DR STE 300
CORAL SPRINGS FL
33076-3374
US

V. Phone/Fax

Practice location:
  • Phone: 561-697-3131
  • Fax:
Mailing address:
  • Phone: 954-509-3650
  • Fax: 954-796-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. J. SCOTT RICHARDSON
Title or Position: SVP, OPS FINANCE & PMI, TENET
Credential:
Phone: 469-893-6960