Provider Demographics
NPI:1861862948
Name:WALDRON INTEGRATED MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:WALDRON INTEGRATED MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-382-4445
Mailing Address - Street 1:11 RYANT BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-8075
Mailing Address - Country:US
Mailing Address - Phone:863-382-4445
Mailing Address - Fax:863-382-4447
Practice Address - Street 1:11 RYANT BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-8075
Practice Address - Country:US
Practice Address - Phone:863-382-4445
Practice Address - Fax:863-382-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty