Healthcare Provider Details

I. General information

NPI: 1619596517
Provider Name (Legal Business Name): INTEEM HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11977 S APOPKA VINELAND RD
ORLANDO FL
32836-7025
US

IV. Provider business mailing address

PO BOX 690316
ORLANDO FL
32869-0316
US

V. Phone/Fax

Practice location:
  • Phone: 863-458-0579
  • Fax:
Mailing address:
  • Phone: 863-458-0579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELINDA R SHORT-RUSSELL
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential: RN, BSN, SFNP
Phone: 863-529-6899