Provider Demographics
NPI:1841663010
Name:OBT FAMILY MEDICAL CLINIC
Entity type:Organization
Organization Name:OBT FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-230-2108
Mailing Address - Street 1:10450 TURKEY LAKE RD
Mailing Address - Street 2:UNIT 691483
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-7501
Mailing Address - Country:US
Mailing Address - Phone:407-230-2108
Mailing Address - Fax:
Practice Address - Street 1:9480 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8321
Practice Address - Country:US
Practice Address - Phone:407-230-2108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care