Provider Demographics
NPI:1437644325
Name:CH AFFILIATES, LLC
Entity Type:Organization
Organization Name:CH AFFILIATES, LLC
Other - Org Name:PRESTIGE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/PA-C
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC, PA-C
Authorized Official - Phone:843-345-2168
Mailing Address - Street 1:5833 S GOLDENROD RD STE 5C&D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8777
Mailing Address - Country:US
Mailing Address - Phone:407-810-8777
Mailing Address - Fax:407-658-0721
Practice Address - Street 1:5833 S GOLDENROD RD STE 5C&D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8777
Practice Address - Country:US
Practice Address - Phone:843-345-2168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107787700Medicaid