Provider Demographics
NPI:1497168173
Name:DOCTORS AT HOME TRI COUNTY
Entity Type:Organization
Organization Name:DOCTORS AT HOME TRI COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-421-8553
Mailing Address - Street 1:11954 NARCOOSSEE RD STE 2 #504
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6998
Mailing Address - Country:US
Mailing Address - Phone:800-925-1840
Mailing Address - Fax:800-521-9406
Practice Address - Street 1:11954 NARCOOSSEE RD STE 2 #504
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6998
Practice Address - Country:US
Practice Address - Phone:800-925-1840
Practice Address - Fax:800-521-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLISUN3OtherBCBS
FL015701100Medicaid