Provider Demographics
NPI:1053388538
Name:FLORIDA INSTITUTE OF RESEARCH MEDICINE AND SURGERY PA
Entity type:Organization
Organization Name:FLORIDA INSTITUTE OF RESEARCH MEDICINE AND SURGERY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS/MNGED CARE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:407-426-8484
Mailing Address - Street 1:70 W GORE ST, CREDENTIALING DEPARTMENT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1124
Mailing Address - Country:US
Mailing Address - Phone:407-426-8484
Mailing Address - Fax:407-447-5229
Practice Address - Street 1:70 W GORE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1124
Practice Address - Country:US
Practice Address - Phone:407-426-8484
Practice Address - Fax:407-426-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1833Medicare ID - Type Unspecified