Healthcare Provider Details

I. General information

NPI: 1902084940
Provider Name (Legal Business Name): THRESHOLD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 NORTH GOLDENROD ROAD
WINTER PARK FL
32792
US

IV. Provider business mailing address

3550 NORTH GOLDENROD ROAD
WINTER PARK FL
32792
US

V. Phone/Fax

Practice location:
  • Phone: 407-671-7060
  • Fax: 407-671-6005
Mailing address:
  • Phone: 407-671-7060
  • Fax: 407-671-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number7292
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. JAMES L. DENNIS
Title or Position: EXECUTIVE DIRECTOR
Credential: ESQUIRE
Phone: 321-527-2064