Provider Demographics
NPI:1821480351
Name:PIECAR COMMUNITY HEALTHCARE LLC
Entity Type:Organization
Organization Name:PIECAR COMMUNITY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-704-8724
Mailing Address - Street 1:PO BOX 682027
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32868-2027
Mailing Address - Country:US
Mailing Address - Phone:407-704-8724
Mailing Address - Fax:407-730-3446
Practice Address - Street 1:724 CHARLES ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7509
Practice Address - Country:US
Practice Address - Phone:407-704-8724
Practice Address - Fax:407-730-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN 278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009942300Medicaid