Provider Demographics
NPI:1689063174
Name:IGLESIA BAUTISTA CENTRAL DE KISSIMMEE, INC.
Entity Type:Organization
Organization Name:IGLESIA BAUTISTA CENTRAL DE KISSIMMEE, INC.
Other - Org Name:IBCK FAMILY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-348-2060
Mailing Address - Street 1:2275 FORTUNE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4404
Mailing Address - Country:US
Mailing Address - Phone:407-348-2060
Mailing Address - Fax:407-348-2063
Practice Address - Street 1:2275 FORTUNE RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4404
Practice Address - Country:US
Practice Address - Phone:407-348-2060
Practice Address - Fax:407-348-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center