Basic Information
| Provider Information | |||||||||
| NPI: | 1174297717 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH FIRST MEDICAL GROUP LLC | ||||||||
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| OtherOrganizationName: | THE ORTHOPEDIC CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 S FISKE BLVD | ||||||||
| Address2: | CREDENTIALING | ||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329554306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214345055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1421 MALABAR RD NE STE 200 | ||||||||
| Address2: | |||||||||
| City: | PALM BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329072559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213082660 | ||||||||
| FaxNumber: | 3219849303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2021 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | MORSE | ||||||||
| AuthorizedOfficialFirstName: | LORA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP PROFESSIONAL FEE SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 3214346116 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 008009000 | 05 | FL | MEDICAID |