NPIMap

Organization Active NPI

Florida PHS LLC

  • Family Medicine Physician
  • Ft. Lauderdale, FL
National Provider Identifier
1801025366
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FLORIDA PHS LLC
Practice address
101 NE Third Avenue
Suite 1500
Ft. Lauderdale, FL 33301-1181
Phone
(901) 261-4848
Fax
(901) 261-4849
NPI assigned
Jul 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

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

Authorized official

Name
Mark Smith
Title
Ceo
Phone
(901) 261-4858

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

101 NE Third Avenue
Suite 1500
Ft. Lauderdale, FL 33301-1181

Mailing address

9155 Crestwyn Hills Dr
Memphis, TN 38125-8501
Phone (877) 260-4758

Other identifiers 1

IdentifierTypeStateIssuer
003107800MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1246838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1801025366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9155 CRESTWYN HILLS DR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381258501",
            "telephone_number": "877-260-4758",
            "fax_number": "901-261-4867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NE THIRD AVENUE",
            "address_2": "SUITE 1500",
            "city": "FT. LAUDERDALE",
            "state": "FL",
            "postal_code": "333011181",
            "telephone_number": "901-261-4848",
            "fax_number": "901-261-4849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA PHS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-06",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "901-261-4858"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003107800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft. Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; 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.