Adv an Ced Florida Medical Group, Corp.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

HCC10633 Issued in FL

Legal business name

ADV AN CED FLORIDA MEDICAL GROUP, CORP.

Practice address

3900 Broadway Ste D-9
Fort Myers, FL 33901-8193

Phone

(239) 590-8570

NPI assigned

Jun 14, 2016

Organization subpart

No

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

Authorized official

Name

Odalis Maza Morejon

Title

President

Phone

(239) 590-8570

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474502400000",
    "number": "1376993980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 BROADWAY, SUITE D-9",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 BROADWAY STE D-9",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339018193",
            "telephone_number": "239-590-8570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADV AN CED FLORIDA MEDICAL GROUP, CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-14",
        "last_updated": "2016-09-22",
        "status": "A",
        "authorized_official_last_name": "MAZA MOREJON",
        "authorized_official_first_name": "ODALIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-590-8570"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "HCC10633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARNP",
            "identifier": "1649626409",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheila Adrace, NP-C
• Kathryn Adrian
• Heather Althea Adu-Sarkodie, DDS, PHD
• Yaw Adu-Sarkodie, PHARM.D.
• Adult Medical Supply Inc
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• Advanced Labs of SW Florida, LLC

• Clinic/Center in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.