1609075951 NPI number — PHYSICIANS OF CENTRAL FLORIDA PA

Table of content: (NPI 1609075951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609075951 NPI number — PHYSICIANS OF CENTRAL FLORIDA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS OF CENTRAL FLORIDA 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:
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:
1609075951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18550 US HIGHWAY 441
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT DORA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32757-6751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-735-3755
Provider Business Mailing Address Fax Number:
352-385-0033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10250 SE 167TH PLACE RD
Provider Second Line Business Practice Location Address:
SUITE 5-3
Provider Business Practice Location Address City Name:
SUMMERFIELD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34491-8682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-307-6674
Provider Business Practice Location Address Fax Number:
352-347-1703
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHANG
Authorized Official First Name:
KHAI
Authorized Official Middle Name:
SHENG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-735-3755

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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