1144265026 NPI number — CENTRAL FLORIDA MEDICAL CARE,PA

Table of content: (NPI 1144265026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144265026 NPI number — CENTRAL FLORIDA MEDICAL CARE,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL FLORIDA MEDICAL CARE,PA
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:
6
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:
1144265026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29320 US HIGHWAY 27
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34748-8227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-360-0400
Provider Business Mailing Address Fax Number:
352-360-0404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29320 US HIGHWAY 27
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34748-8227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-360-0400
Provider Business Practice Location Address Fax Number:
352-360-0404
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LICHTINGER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
352-360-0400

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0S0006324 , 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)

  • Identifier: 371631700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH3810 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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