| Source Medical Group, LLC | |
|
208 Se 8th St Ft Lauderdale FL 33316-1014 | |
| (561) 704-6781 | |
| Not Available |
| Full Name | Source Medical Group, LLC |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 208 Se 8th St, Ft Lauderdale, Florida |
| Authorized Official Name and Position | Troy Garr (AMBR) |
| Authorized Official Contact | 2155708300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Source Medical Group, LLC 7601 N Federal Hwy Ste 245a Boca Raton FL 33487-1672 | Source Medical Group, LLC 208 Se 8th St Ft Lauderdale FL 33316-1014 Ph: (561) 704-6781 |
| NPI Number | 1871358853 |
|---|---|
| Provider Enumeration Date | 02/19/2024 |
| Last Update Date | 02/19/2024 |
| Certification Date | 02/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871358853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
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