Provider Demographics
NPI:1922766823
Name:MEDSTATION DR PHILLIPS LLC
Entity Type:Organization
Organization Name:MEDSTATION DR PHILLIPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:BARROS
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:407-530-8744
Mailing Address - Street 1:8972 TURKEY LAKE RD # A700
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7377
Mailing Address - Country:US
Mailing Address - Phone:407-530-8744
Mailing Address - Fax:407-210-5616
Practice Address - Street 1:8972 TURKEY LAKE RD # A700
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7377
Practice Address - Country:US
Practice Address - Phone:407-530-8744
Practice Address - Fax:407-210-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care