Myrtle Ridge Family Medicine, Pa

LBN: Myrtle Ridge Family Medicine, Pa
Myrtle Ridge Family Medicine, Pa is an health care organization with primary practice located at 1539 Dale Mabry Hwy 102, Lutz FL 33548-3008. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Myrtle Ridge Family Medicine, Pa can be contacted via phone (813) 909-7102, or through Bergh, Jack via phone (813) 909-7102.

Contact Information

Primary practice address
1539 Dale Mabry Hwy 102 Lutz FL 33548-3008
Phone: (813) 909-7102
Fax: (813) 909-0199
Website:
Map and Directions
Authorized official contact:
Name: Bergh, Jack Doctor of Medicine (MD)
Phone: (813) 909-7102

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME0056971 Florida

Profile Details

NPI number 1427195809
LBN Legal business name Myrtle Ridge Family Medicine, Pa
DBA Doing business as
Authorized official Bergh, Jack Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 1st, 2007
Last updated Jan 10th, 2013 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427195809 NPPES
Florida MEDICAID 770008300

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