NPIMap

Organization Active NPI

Millennium Physician Group LLC

  • Family Medicine Physician
  • Punta Gorda, FL
National Provider Identifier
1326701319
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MILLENNIUM PHYSICIAN GROUP LLC
Practice address
315 E Olympia Ave Unit 111
Punta Gorda, FL 33950-3823
Phone
(941) 369-1640
Fax
(941) 637-9808
NPI assigned
Oct 18, 2021
Last updated
Jan 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Haltigan
Title
Director of Revenue Cycle
Phone
(877) 856-3774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

315 E Olympia Ave Unit 111
Punta Gorda, FL 33950-3823

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1096190Millennium Physician Group LLC315 E Olympia Ave Ste 112, Punta Gorda, FL 33950Certificate of waiverFeb 25, 2027
10D1098671Millennium Physician Group LLC315 E Olympia Ave Ste 111, Punta Gorda, FL 33950Certificate of waiverApr 23, 2027
10D2173907Millennium Physician Group, LLC315 E Olympia Ave Suite 213, Punta Gorda, FL 33950Certificate of waiverOct 21, 2027
10D2340288Millennium Physician Group, LLC315 E Olympia Ave Suite 223, Punta Gorda, FL 33950Certificate of waiverMar 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
Millennium Physician Group LLC123 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674000000000",
    "number": "1326701319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774",
            "fax_number": "239-599-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E OLYMPIA AVE UNIT 111",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339503823",
            "telephone_number": "941-369-1640",
            "fax_number": "941-637-9808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLENNIUM PHYSICIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-18",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A",
        "authorized_official_last_name": "HALTIGAN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "877-856-3774"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Punta Gorda, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.