Healthcare Provider Details

I. General information

NPI: 1427498724
Provider Name (Legal Business Name): TOWN CENTER MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 DUNLAWTON AVE STE 120
PORT ORANGE FL
32127-8980
US

IV. Provider business mailing address

1690 DUNLAWTON AVE STE 120
PORT ORANGE FL
32127-8980
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: AMMAR HEMAIDAN
Title or Position: OWNER
Credential: MD
Phone: 386-271-2273