MEDICARE: HEALTH MEDICAL ULTRA LIMITED LIABILITY COMPANY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LF0000X	Family Nurse Practitioner
2	208D00000X	General Practice Physician
3	207QA0505X	Adult Medicine Physician

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	:	1942829536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH MEDICAL ULTRA LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	2402 LAKE DR NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-5008
Country	:	US
Telephone Number	:	863-662-3007
Fax Number	:	863-875-4681

Provider Business Practice Location Address
First Line	:	2402 LAKE DR NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-5008
Country	:	US
Telephone Number	:	863-662-3007
Fax Number	:	863-875-4681

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MARIA I DIEZ
Credential	:
Telephone Number	:	786-399-5995

Provider Enumeration Date	:	04/13/2020
Last Update Date	:	05/28/2026

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Directions to “HEALTH MEDICAL ULTRA LIMITED LIABILITY COMPANY ” Practice Location

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