Provider Demographics
NPI:1669027231
Name:PHRC ORLANDO PLLC
Entity Type:Organization
Organization Name:PHRC ORLANDO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-462-2588
Mailing Address - Street 1:5510 N HESPERIDES ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5414
Mailing Address - Country:US
Mailing Address - Phone:813-462-2588
Mailing Address - Fax:
Practice Address - Street 1:5510 N HESPERIDES ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5414
Practice Address - Country:US
Practice Address - Phone:813-462-2588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service