HEATHROW INTERNAL MEDICINE LLC NPI 1033387865

NPI Information

  • NPI: 1033387865
  • Provider Name: HEATHROW INTERNAL MEDICINE LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 10D0705869
  • Address: 4106 W LAKE MARY BLVD
    SUITE 100
    LAKE MARY, FL
    ZIP 32746
  • Phone: (407) 333-2273

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NPI Details

HEATHROW INTERNAL MEDICINE LLC is a family medicine in Lake Mary, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. HEATHROW INTERNAL MEDICINE LLC NPI is 1033387865. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4106 W LAKE MARY BLVD
SUITE 100
LAKE MARY, FL
ZIP 32746-315
Phone: (407) 333-2273
Fax: (407) 333-3939

The provider's authorized official is Tedrick Johnson .
The authorized official title is Group Vp Operations and has the following contact phone number (407) 333-2273.

The CLIA number assigned to this NPI record is 10D0705869 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/14/2008 and was last updated on 5/28/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal MedicineNo
2207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1PTAN DN9084OTHERFLORIDAMEDICARE RAILROAD
2AM199OTHERFLORIDAMEDICARE PTAN
3307909100MEDICAIDFLORIDA
4000617400MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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