The Source FL Professional Services, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

THE SOURCE FL PROFESSIONAL SERVICES, LLC

Practice address

1730 E Commercial Blvd
Oakland Park, FL 33334-5721

Phone

(954) 288-2555

NPI assigned

Sep 28, 2019

Last updated

Nov 22, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark J Korcok

Title

President

Phone

(954) 288-2555

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1569628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574380800000",
    "number": "1588215784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 E COMMERCIAL BLVD",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333345721",
            "telephone_number": "954-288-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 E COMMERCIAL BLVD",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333345721",
            "telephone_number": "954-288-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOURCE FL PROFESSIONAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-28",
        "last_updated": "2019-11-22",
        "status": "A",
        "authorized_official_last_name": "KORCOK",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-288-2555"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Oakland Park, FL
• Providers in Oakland Park, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; 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.