Provider Demographics
NPI:1902812662
Name:FLORIDA INTEGRATIVE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:FLORIDA INTEGRATIVE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PYLANT
Authorized Official - Last Name:MONHOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-955-6220
Mailing Address - Street 1:2415 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2809
Mailing Address - Country:US
Mailing Address - Phone:941-955-6220
Mailing Address - Fax:941-955-1410
Practice Address - Street 1:2415 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 218
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2809
Practice Address - Country:US
Practice Address - Phone:941-955-6220
Practice Address - Fax:941-955-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI25097Medicare UPIN