Provider Demographics
NPI:1083774178
Name:ALTAMONTE PRIMARY CARE, INC
Entity Type:Organization
Organization Name:ALTAMONTE PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-889-0007
Mailing Address - Street 1:1706 E SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1706 E SEMORAN BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5651
Practice Address - Country:US
Practice Address - Phone:407-889-0007
Practice Address - Fax:407-889-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME038388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257631700Medicaid
FL257631700Medicaid