Healthcare Provider Details

I. General information

NPI: 1720504947
Provider Name (Legal Business Name): MEDHEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 CYPRESS GARDENS BLVD
WINTER HAVEN FL
33880
US

IV. Provider business mailing address

121 S ORANGE AVE STE 940
ORLANDO FL
32801-3234
US

V. Phone/Fax

Practice location:
  • Phone: 407-658-9687
  • Fax: 407-658-9688
Mailing address:
  • Phone: 407-658-9687
  • Fax: 407-658-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. LYZETTE LORENZ
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 407-658-9687