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FAMILY HEALTH CENTER AT PORT ST JOHN LLC NPI 1851575377


NPI Information

NPI: 1851575377
Provider Name: FAMILY HEALTH CENTER AT PORT ST JOHN LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 10D1081504

Address:
3740 CURTIS BLVD
SUITE 108
COCOA, FL
ZIP 32927
Phone: (321) 633-5500
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FAMILY HEALTH CENTER AT PORT ST JOHN LLC is a family medicine in Cocoa, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. FAMILY HEALTH CENTER AT PORT ST JOHN LLC NPI is 1851575377. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3740 CURTIS BLVD
SUITE 108
COCOA, FL
ZIP 32927-962
Phone: (321) 633-5500
Fax: (321) 633-5566

The provider's authorized official is Janis G Black .
The authorized official title is Physician/owner and has the following contact phone number (321) 633-5500.

The CLIA number assigned to this NPI record is 10D1081504 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 12/19/2007 and was last updated on 12/3/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineOS9694FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1I62653MEDICARE UPINFLORIDA
22753011400MEDICAIDFLORIDA
3U8317ZMEDICARE PINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.