Healthcare Provider Details

I. General information

NPI: 1528465499
Provider Name (Legal Business Name): UNITED SPECIALTY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 CENTERPOINTE CIR SUITE 1481
ALTAMONTE SPRINGS FL
32701-3453
US

IV. Provider business mailing address

393 CENTERPOINTE CIR SUITE 1481
ALTAMONTE SPRINGS FL
32701-3453
US

V. Phone/Fax

Practice location:
  • Phone: 321-280-3949
  • Fax: 321-280-3950
Mailing address:
  • Phone: 321-280-3949
  • Fax: 321-280-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME10299
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberME108299
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberME108299
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME108299
License Number StateFL

VIII. Authorized Official

Name: WALTER L SEIFERT
Title or Position: OWNER
Credential: M.D.
Phone: 321-280-3949