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NPI Code Detail

MEDICARE: ULTRA HEALTH PROVIDERS OF FLORIDA

MEDICARE: ULTRA HEALTH PROVIDERS OF FLORIDA
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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician
2363L00000XNurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528549490
Entity Type Code : Organization
Provider Name (Legal Business Name) : ULTRA HEALTH PROVIDERS OF FLORIDA
Provider Business Mailing Address
First Line : PO BOX 269092
Second Line : DEPT 1103
City : OKLAHOMA CITY
State : OK
Zip : 73126-9092
Country : US
Telephone Number : 731-394-1145
Fax Number :
Provider Business Practice Location Address
First Line : 701 N WILDER RD
Second Line :
City : PLANT CITY
State : FL
Zip : 33566-7547
Country : US
Telephone Number : 386-562-4899
Fax Number :
Authorized Official
Title or Position : CEO
Name : TIMOTHY MARTINEZ
Credential :
Telephone Number : 312-806-0466
Provider Enumeration Date : 08/28/2018
Last Update Date : 06/19/2026

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Directions to “ULTRA HEALTH PROVIDERS OF FLORIDA ” Practice Location

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