Healthcare Provider Details

I. General information

NPI: 1265246383
Provider Name (Legal Business Name): FLORIDA HOSPITAL MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N LAKEMONT AVE STE 207
WINTER PARK FL
32792-3219
US

IV. Provider business mailing address

PO BOX 935933
ATLANTA GA
31193-5933
US

V. Phone/Fax

Practice location:
  • Phone: 844-407-4070
  • Fax:
Mailing address:
  • Phone: 800-737-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

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