Healthcare Provider Details

I. General information

NPI: 1548273139
Provider Name (Legal Business Name): MAINSTREET MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8723 INTERNATIONAL DR SUITE 115
ORLANDO FL
32819-9337
US

IV. Provider business mailing address

8723 INTERNATIONAL DR SUITE 115
ORLANDO FL
32819-9337
US

V. Phone/Fax

Practice location:
  • Phone: 407-370-4881
  • Fax: 407-370-4867
Mailing address:
  • Phone: 407-370-4881
  • Fax: 407-370-4867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANA S. GAUCHAT
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-348-0990