Provider Demographics
NPI:1295181808
Name:WINTER SPRINGS INVESCO LLC
Entity Type:Organization
Organization Name:WINTER SPRINGS INVESCO LLC
Other - Org Name:HAYES MEDICAL WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KANTILAL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BHALANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-289-1951
Mailing Address - Street 1:701 E SR 434
Mailing Address - Street 2:SUITE 1031
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-2701
Mailing Address - Country:US
Mailing Address - Phone:321-289-1951
Mailing Address - Fax:
Practice Address - Street 1:701 E SR 434
Practice Address - Street 2:SUITE 1031
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-2701
Practice Address - Country:US
Practice Address - Phone:321-289-1951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty