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General NPI Number Information
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NPI Number | 1477134658
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Entity Type | Organization
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Legal Business Name | FLORIDA INTERVENTIONAL PROVIDERS, LLC
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 2202 SE 23RD RD
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City | HOMESTEAD
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State | FL
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Zip | 33035-1904
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Country | US
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Telephone | 201-951-3113
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Fax | 305-675-3346
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Provider Business Mailing Address
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Address Line | 2202 SE 23RD RD
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City | HOMESTEAD
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State | FL
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Zip | 33035-1904
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Country | US
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Telephone | 201-951-3113
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Fax | 305-675-3346
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DARRELL JOHNSON
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Credential |
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Telephone | 561-356-6313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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