Healthcare Provider Details

I. General information

NPI: 1174730303
Provider Name (Legal Business Name): BUENA VISTA CONCESSIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2697 W FAIRBANKS AVE
WINTER PARK FL
32789-3348
US

IV. Provider business mailing address

940 MOSS TREE PL
LONGWOOD FL
32750-4069
US

V. Phone/Fax

Practice location:
  • Phone: 407-938-0349
  • Fax: 407-331-8597
Mailing address:
  • Phone: 407-718-5039
  • Fax: 407-331-8597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SMITH
Title or Position: PRESIDENT
Credential:
Phone: 407-718-5039