Healthcare Provider Details

I. General information

NPI: 1902465610
Provider Name (Legal Business Name): PRIME HEALTH OF CENTRAL FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 HEALTH BLVD
DAYTONA BEACH FL
32114-1493
US

IV. Provider business mailing address

608 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-6834
US

V. Phone/Fax

Practice location:
  • Phone: 386-256-4031
  • Fax: 386-256-7151
Mailing address:
  • Phone: 386-271-2273
  • Fax: 386-271-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: OSMAN AHMAD
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 321-274-7519