Provider Demographics
NPI:1023335296
Name:ISPM OF FLORIDA
Entity type:Organization
Organization Name:ISPM OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-205-0270
Mailing Address - Street 1:3400 PEACHTREE RD NE
Mailing Address - Street 2:STE 811
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1107
Mailing Address - Country:US
Mailing Address - Phone:941-205-0270
Mailing Address - Fax:941-205-0276
Practice Address - Street 1:610 EAST OLYMPIA BLVD
Practice Address - Street 2:STE 202
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3875
Practice Address - Country:US
Practice Address - Phone:941-833-1100
Practice Address - Fax:941-637-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty