Provider Demographics
NPI:1205361508
Name:COMPREHENSIVE HEALTH CENTER OF ORLANDO, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE HEALTH CENTER OF ORLANDO, LLC
Other - Org Name:COMPREHENSIVE HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER-CERTIFIED
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-688-4178
Mailing Address - Street 1:1018 W OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4710
Mailing Address - Country:US
Mailing Address - Phone:407-859-8797
Mailing Address - Fax:407-859-8798
Practice Address - Street 1:1018 W OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4710
Practice Address - Country:US
Practice Address - Phone:407-859-8797
Practice Address - Fax:407-859-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS04440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty