| NPI | 1104166735 |
|---|---|
| Doing Business As | BASIC |
| Entity Type | Organization |
| Authorized Contact | KEYNE K JOHNSON Medical Director 407-378-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL me 102412) |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2013-02-19 |