Healthcare Provider Details

I. General information

NPI: 1861862948
Provider Name (Legal Business Name): WALDRON INTEGRATED MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RYANT BLVD
SEBRING FL
33870-8075
US

IV. Provider business mailing address

11 RYANT BLVD
SEBRING FL
33870-8075
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-4445
  • Fax: 863-382-4447
Mailing address:
  • Phone: 863-382-4445
  • Fax: 863-382-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID WALDRON
Title or Position: OWNER
Credential:
Phone: 863-382-4445