Myrtle Ridge Family Medicine, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME0056971 Issued in FL

Legal business name

MYRTLE RIDGE FAMILY MEDICINE, PA

Practice address

1539 Dale Mabry Hwy
102
Lutz, FL 33548-3008

Phone

(813) 909-7102

Fax

(813) 909-0199

NPI assigned

Feb 1, 2007

Organization subpart

No

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

Authorized official

Name

Jack Bergh, MD

Title

Ceo

Phone

(813) 909-7102

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357776000000",
    "number": "1427195809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335480660",
            "telephone_number": "813-909-7102",
            "fax_number": "813-909-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 DALE MABRY HWY",
            "address_2": "102",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335483008",
            "telephone_number": "813-909-7102",
            "fax_number": "813-909-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRTLE RIDGE FAMILY MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2013-01-10",
        "status": "A",
        "authorized_official_last_name": "BERGH",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "813-909-7102",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0056971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "770008300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynda Jean Myers, LMT
• Robin Andrew Myers, DOM, A.P.
• Terrence Cameron Myers Jr., PHARMD
• Myofascial Release and Women's Health LLC (Holistic Health Practitioners)
• Callie Myrick
• Myrtle Ridge Healthcare Center, LLC
• Myrtle Ridge Primary Care, P.a
• Myrtle Ridge Primary Care, P.a
• N Shape & Health Medicine LLC
• Marie Louise Nace

• Family Medicine Physician in Lutz, FL
• Providers in Lutz, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; 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.