Organization
FAMILY HEALTH CENTER AT PORT ST JOHN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JANIS G BLACK D.O. (PHYSICIAN/OWNER)
(321) 633-5500
Entity
Organization
Contact information
Practice address
3740 CURTIS BLVD, SUITE 108, COCOA, FL 32927-3962
(321) 633-5500
(321) 633-5566
Mailing address
3740 CURTIS BLVD, SUITE 108, COCOA, FL 32927-3962
(321) 633-5500
(321) 633-5566
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS9694
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2753011400
—
FL
Enumeration date
12/19/2007
Last updated
12/03/2013
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