Basic Information
| Provider Information | |||||||||
| NPI: | 1073515623 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRINGS FAMILY MEDICAL CENTER,PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10200 YALE AVE | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346138375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525971960 | ||||||||
| FaxNumber: | 3525979470 | ||||||||
| Practice Location | |||||||||
| Address1: | 10200 YALE AVE | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346138375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525971960 | ||||||||
| FaxNumber: | 3525979470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 05/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRIJBAG | ||||||||
| AuthorizedOfficialFirstName: | DIANA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3525971960 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CMM.CPC,CCP,CSMCS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OSOO6159 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS006150 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 253212300 | 05 | FL | MEDICAID | CL7567 | 01 | FL | TRAVELERS MEDICARE GROUP | OTHER |