Organization
FLORIDA PHS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SMITH (CEO)
(901) 261-4858
Entity
Organization
Contact information
Practice address
101 NE THIRD AVENUE, SUITE 1500, FT. LAUDERDALE, FL 33301-1181
(901) 261-4848
(901) 261-4849
Mailing address
9155 CRESTWYN HILLS DR, MEMPHIS, TN 38125-8501
(877) 260-4758
(901) 261-4867
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003107800
—
FL
Enumeration date
07/06/2009
Last updated
10/25/2012
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