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General NPI Number Information
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NPI Number | 1336856731
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Entity Type | Organization
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Legal Business Name | FLORIDA REGIONAL INTENSIVIST SERVICES, LLC
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 449 W 23RD ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-4507
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Country | US
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Telephone | 850-769-8341
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 80325
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City | PHILADELPHIA
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State | PA
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Zip | 19101-1325
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Country | US
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Telephone | 973-251-1132
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KAREN VAUGHN
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Credential |
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Telephone | 973-251-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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