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Organization

OAKRIDGE MEDICAL GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. FRITZ PHANORD (BUSINESS OFFICE MANAGER)
(954) 958-0606
Entity
Organization

Contact information

Practice address
1000 NE 56TH ST, ATTN BUSINESS OFFICE, FORT LAUDERDALE, FL 33334-4149
(954) 958-0606
(954) 776-0821
Mailing address
1000 NE 56TH ST, ATTN BUSINESS OFFICE, FORT LAUDERDALE, FL 33334-4149
(954) 958-0606
(954) 776-0821

Taxonomy

Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
JR3583900
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00002536540 02
UNITED HLTHCR ID
FL
01
214355
AMERIGROUP PROVIDER ID
FL
01
221601
FDA#
FL
01
280077
AVMED PROVIDER ID
FL
01
498
TOTAL HLTH CHOICE ID
FL
01
7726045
AETNA PROVIDER ID
FL
01
SG067359
VISTA HLTHCR ID
FL
01
V2224
BC BS PROVIDER ID
FL
Enumeration date
01/23/2007
Last updated
08/22/2020
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