Provider Demographics
NPI:1114064565
Name:CENTRAL FLORIDA HEALTH CLINICS, LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA HEALTH CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-843-8822
Mailing Address - Street 1:2873 S DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5412
Mailing Address - Country:US
Mailing Address - Phone:407-843-8822
Mailing Address - Fax:407-843-8826
Practice Address - Street 1:2873 S DELANEY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5412
Practice Address - Country:US
Practice Address - Phone:407-843-8822
Practice Address - Fax:407-843-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-75691261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9452Medicare ID - Type UnspecifiedMEDICARE NUMBER