Provider Demographics
NPI:1659562957
Name:ST. ANTHONY'S FAMILY MEDICAL PRACTICE M.D.
Entity Type:Organization
Organization Name:ST. ANTHONY'S FAMILY MEDICAL PRACTICE M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-299-6160
Mailing Address - Street 1:1768 PARK CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6200
Mailing Address - Country:US
Mailing Address - Phone:407-299-6160
Mailing Address - Fax:407-299-9141
Practice Address - Street 1:1768 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32861
Practice Address - Country:US
Practice Address - Phone:407-299-6160
Practice Address - Fax:407-299-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70004261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care