MEDICARE: FLORIDA HOSPITAL MEDICAL GROUP INC

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1881408904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA HOSPITAL MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 935933
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-5933
Country	:	US
Telephone Number	:	800-737-5654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 PATTERSON TER
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2203
Country	:	US
Telephone Number	:	844-407-4070
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. VANCE ALAN MCLARREN II
Credential	:
Telephone Number	:	407-200-2700

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	02/07/2025

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