Provider Demographics
NPI:1255642518
Name:AVALON PARK URGENT CARE
Entity type:Organization
Organization Name:AVALON PARK URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHADWICH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-936-4635
Mailing Address - Street 1:3861 AVALON PARK EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4853
Mailing Address - Country:US
Mailing Address - Phone:407-282-4440
Mailing Address - Fax:407-282-4050
Practice Address - Street 1:3861 AVALON PARK EAST BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4853
Practice Address - Country:US
Practice Address - Phone:407-282-4440
Practice Address - Fax:407-282-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76171261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care