MEDICARE: FLORIDA DEPARTMENT OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1102X	Military Outpatient Operational (Transportable) Component Clinic/Center
2	251K00000X	Public Health or Welfare Agency		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	051925192	OTHER	MEDIPASS
3	051925193	OTHER	MEDIPASS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	051925191	OTHER	MEDIPASS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386751907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	2565 JUDGE FRAN JAMIESON WAY
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-5998
Country	:	US
Telephone Number	:	321-454-7148
Fax Number	:	321-449-5015

Provider Business Practice Location Address
First Line	:	2555 JUDGE FRAN JAMIESON WAY
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-5998
Country	:	US
Telephone Number	:	321-639-5800
Fax Number	:	321-449-5015

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MURRAY F DWECK
Credential	:	MD
Telephone Number	:	321-454-7148

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	05/20/2021

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Directions to “FLORIDA DEPARTMENT OF HEALTH ” Practice Location

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