Healthcare Provider Details

I. General information

NPI: 1962048173
Provider Name (Legal Business Name): METRO TREATMENT OF FLORIDA, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5794 S SEMORAN BLVD
ORLANDO FL
32822-4819
US

IV. Provider business mailing address

2500 MAITLAND CENTER PKWY STE 250
MAITLAND FL
32751-4174
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-7080
  • Fax:
Mailing address:
  • Phone: 407-351-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207ZC0008X
TaxonomyClinical Informatics (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA JACKSON
Title or Position: CFO
Credential:
Phone: 407-351-7080