Basic Information
| Provider Information | |||||||||
| NPI: | 1184681355 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GMS FLORIDA WEST COAST INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15320 AMBERLY DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336471647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139770733 | ||||||||
| FaxNumber: | 8139712230 | ||||||||
| Practice Location | |||||||||
| Address1: | 15320 AMBERLY DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336471647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139770733 | ||||||||
| FaxNumber: | 8139712230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2006 | ||||||||
| LastUpdateDate: | 08/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | EDKINS | ||||||||
| AuthorizedOfficialFirstName: | CYNDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8139770733 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.