Basic Information
| Provider Information | |||||||||
| NPI: | 1063407070 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NES OF FLORIDA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 409036 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303849036 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6500 W NEWBERRY RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523334900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | OSBERG | ||||||||
| AuthorizedOfficialFirstName: | ARTHUR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8886891430 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 72082 | 01 | FL | BCBS GROUP | OTHER | CC1092 | 01 | FL | RR MCR GROUP | OTHER |