MEDICARE: CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336579572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	2400 STATE ROAD 415
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-6012
Country	:	US
Telephone Number	:	407-322-8645
Fax Number	:	407-330-5074

Provider Business Practice Location Address
First Line	:	4949 SILVER STAR RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-4539
Country	:	US
Telephone Number	:	407-322-8645
Fax Number	:	407-330-5074

Authorized Official
Title or Position	:	CEO/CMO
Name	:	DR. LESLIE SMITH
Credential	:	D.O.
Telephone Number	:	407-322-8645

Provider Enumeration Date	:	11/26/2013
Last Update Date	:	11/26/2013

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