1730107780 NPI number — PREMCARE FAMILY MEDICAL CENTER

Table of content: (NPI 1730107780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730107780 NPI number — PREMCARE FAMILY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMCARE FAMILY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730107780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 S SEMORAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32822-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-380-1428
Provider Business Mailing Address Fax Number:
407-380-0754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 S SEMORAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32822-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-380-1428
Provider Business Practice Location Address Fax Number:
407-380-0754
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AWAN
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICINE DOCTOR
Authorized Official Telephone Number:
407-380-1428

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0068874 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com