Provider Demographics
NPI:1164418919
Name:CENTRAL FLORIDA HEALTH CARE INC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA HEALTH CARE INC
Other - Org Name:JUST FOR HER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FULSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-452-3000
Mailing Address - Street 1:950 COUNTY ROAD 17A W
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2164
Mailing Address - Country:US
Mailing Address - Phone:863-452-3000
Mailing Address - Fax:863-452-3069
Practice Address - Street 1:417 CARLTON ST
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3405
Practice Address - Country:US
Practice Address - Phone:863-773-0336
Practice Address - Fax:863-773-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101962Medicare PIN