1407324213 NPI number — COMBINED HEALTH CENTER CORP

Table of content: (NPI 1407324213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407324213 NPI number — COMBINED HEALTH CENTER CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMBINED HEALTH CENTER CORP
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:
COMBINED HEALTH CENTER CORP
Provider Other Organization Name Type Code:
4
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:
1407324213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1417 N SEMORAN BLVD STE 104
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:
32807-3555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-587-9848
Provider Business Mailing Address Fax Number:
407-705-2152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1417 N SEMORAN BLVD STE 104
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:
32807-3555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-587-9848
Provider Business Practice Location Address Fax Number:
407-705-2152
Provider Enumeration Date:
11/09/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DELGADO
Authorized Official First Name:
ADRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
407-704-7633

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 119018700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".