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General NPI Number Information
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NPI Number | 1023033669
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Entity Type | Organization
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Legal Business Name | FLORIDA RESPIRATORY-ST LUCIE INC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 1985 71ST AVE
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City | VERO BEACH
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State | FL
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Zip | 32966-7915
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Country | US
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Telephone | 772-778-2101
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Fax | 772-778-2102
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Provider Business Mailing Address
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Address Line | 1985 71ST AVE
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City | VERO BEACH
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State | FL
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Zip | 32966-7915
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Country | US
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Telephone | 772-778-2101
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Fax | 772-778-2102
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Authorized Official
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Title or Position | GM/PRESIDENT
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Name | STEPHEN ERIC JORDAN
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Credential |
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Telephone | 772-778-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC6082
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License Number State | FL
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