Basic Information
| Provider Information | |||||||||
| NPI: | 1487392726 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH FIRST MEDICAL GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 S FISKE BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329554306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214345055 | ||||||||
| FaxNumber: | 3214344642 | ||||||||
| Practice Location | |||||||||
| Address1: | 661 E ALTAMONTE DR STE 224 | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078309000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2022 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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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: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00800900 | 05 | FL | MEDICAID |