FM Medical Clinic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

FM MEDICAL CLINIC LLC

Practice address

165 Southpark Blvd
St Augustine, FL 32086-4101

Phone

(904) 823-8833

Fax

(904) 823-9394

NPI assigned

Mar 16, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Scott R Michaels, MD

Title

Clinic Director

Phone

(904) 823-8833

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1891298790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 SOUTHPARK BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864101",
            "telephone_number": "904-823-8833",
            "fax_number": "904-823-9394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 SOUTHPARK BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864101",
            "telephone_number": "904-823-8833",
            "fax_number": "904-823-9394"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3560 AIA South",
            "address_purpose": "LOCATION",
            "city": "ST AUGUSTINE Beach",
            "state": "FL",
            "postal_code": "32086",
            "country_code": "US",
            "telephone_number": "904-823-8833 x103",
            "fax_number": "904-823-9394",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FM MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-16",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "MICHAELS",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "904-823-8833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSES",
            "identifier": "M242796603210",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.