| Organization Name: | FCC COLEMAN |
| NPI Number: | 1013146877 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IVAN NEGRON (COMPLEX CLINICAL DIRECTOR) |
| Mailing Address: | 846 Ne 54th Terrace Coleman |
| State: | FL US |
| Postal Code: | 335211029 |
| Phone Number: | 3526893018 |
| Fax Number: | |
| NPI Enumeration Date: | 07/14/2009 |
| NPI Last Update Date: | 07/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Prison Health |
| Taxonomy Definition: | |