Provider Demographics
NPI:1801479878
Name:UNITY MEDICAL CENTER & SERVICES LLC
Entity type:Organization
Organization Name:UNITY MEDICAL CENTER & SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATACHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-410-4501
Mailing Address - Street 1:2543 SUMMER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-4753
Mailing Address - Country:US
Mailing Address - Phone:561-410-4501
Mailing Address - Fax:
Practice Address - Street 1:1511 PROSPERITY FARMS RD
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2046
Practice Address - Country:US
Practice Address - Phone:508-345-2365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730454323OtherINDIVIDUAL NPI FOR MEDICAL DIRECTOR JOEL PELISSIER
FL1730454323Medicaid