Provider Demographics
NPI:1720504947
Name:MEDHEALTH GROUP, LLC
Entity Type:Organization
Organization Name:MEDHEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LYZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-658-9687
Mailing Address - Street 1:121 S ORANGE AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3234
Mailing Address - Country:US
Mailing Address - Phone:407-658-9687
Mailing Address - Fax:407-658-9688
Practice Address - Street 1:395 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880
Practice Address - Country:US
Practice Address - Phone:407-658-9687
Practice Address - Fax:407-658-9688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDHEALTH GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-18
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6B5KOtherFL BLUE