MEDICARE: BVL FAMILY PRACTICE AND SPECIALTY 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	261QP2300X	Primary Care Clinic/Center

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	:	1497770408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BVL FAMILY PRACTICE AND SPECIALTY CENTER, INC

Provider Business Mailing Address
First Line	:	2551 BOGGY CREEK RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-3806
Country	:	US
Telephone Number	:	407-348-0990
Fax Number	:	407-944-9041

Provider Business Practice Location Address
First Line	:	2551 BOGGY CREEK RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-3806
Country	:	US
Telephone Number	:	407-348-0990
Fax Number	:	407-944-9041

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. DIANA S. GAUCHAT
Credential	:
Telephone Number	:	407-348-0990

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/03/2012

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