Basic Information
| Provider Information | |||||||||
| NPI: | 1346996733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH FIRST MEDICAL GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 S FISKE BLVD | ||||||||
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| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329554306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214345055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 699 W COCOA BEACH CSWY STE 401 | ||||||||
| Address2: | |||||||||
| City: | COCOA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329313562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217845437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2022 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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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: | 02/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 008009000 | 05 | FL | MEDICAID |