Provider Demographics
NPI:1164192381
Name:BLISS SPECIALTY HEALTHCARE GROUP
Entity Type:Organization
Organization Name:BLISS SPECIALTY HEALTHCARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-205-9149
Mailing Address - Street 1:6388 SILVER STAR RD STE 2H
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3235
Mailing Address - Country:US
Mailing Address - Phone:407-704-1771
Mailing Address - Fax:866-522-0166
Practice Address - Street 1:6388 SILVER STAR RD STE 2H
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3235
Practice Address - Country:US
Practice Address - Phone:352-205-9149
Practice Address - Fax:866-341-7847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine