Provider Demographics
NPI:1679671200
Name:BLOCK NATION CHASE SMOLEN FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:BLOCK NATION CHASE SMOLEN FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-678-6888
Mailing Address - Street 1:2441 WEST STATE ROAD 426
Mailing Address - Street 2:SUITE 2011
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4515
Mailing Address - Country:US
Mailing Address - Phone:407-678-6888
Mailing Address - Fax:407-678-0252
Practice Address - Street 1:2441 WEST STATE ROAD 426
Practice Address - Street 2:SUITE 2011
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4515
Practice Address - Country:US
Practice Address - Phone:407-678-6888
Practice Address - Fax:407-678-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061495261QP2300X
FLOS0007059261QP2300X
FLME0074034261QP2300X
FLME90314261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0007Medicare PIN