Provider Demographics
NPI:1144626771
Name:CENTRAL FLORIDA PEDIATRIC URGENT CARE, LLC
Entity type:Organization
Organization Name:CENTRAL FLORIDA PEDIATRIC URGENT CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-865-6564
Mailing Address - Street 1:425 S HUNT CLUB BLVD
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-2428
Mailing Address - Country:US
Mailing Address - Phone:407-865-6564
Mailing Address - Fax:
Practice Address - Street 1:425 S HUNT CLUB BLVD
Practice Address - Street 2:SUITE 1001
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4947
Practice Address - Country:US
Practice Address - Phone:407-865-6564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME680942080A0000X
FL261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016916500Medicaid