Provider Demographics
NPI:1801351184
Name:SLF MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:SLF MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:FORT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-224-8161
Mailing Address - Street 1:2528 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2743
Mailing Address - Country:US
Mailing Address - Phone:352-224-8161
Mailing Address - Fax:321-320-8780
Practice Address - Street 1:2528 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-2743
Practice Address - Country:US
Practice Address - Phone:352-224-8161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty