Provider Demographics
NPI:1427204502
Name:MEDICAL CLINIC OF OSCEOLA LLC
Entity Type:Organization
Organization Name:MEDICAL CLINIC OF OSCEOLA LLC
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRADO
Authorized Official - Middle Name:ELYERAN
Authorized Official - Last Name:TALAMPAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-931-1998
Mailing Address - Street 1:1506 VILLAGE OAK LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-6558
Mailing Address - Country:US
Mailing Address - Phone:407-931-1998
Mailing Address - Fax:407-931-0522
Practice Address - Street 1:1506 VILLAGE OAK LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-6558
Practice Address - Country:US
Practice Address - Phone:407-931-1998
Practice Address - Fax:407-931-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84870261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG89060Medicare UPIN