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General NPI Number Information
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NPI Number | 1174730303
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Entity Type | Organization
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Legal Business Name | BUENA VISTA CONCESSIONS, INC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2697 W FAIRBANKS AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-3348
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Country | US
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Telephone | 407-938-0349
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Fax | 407-331-8597
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Provider Business Mailing Address
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Address Line | 940 MOSS TREE PL
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City | LONGWOOD
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State | FL
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Zip | 32750-4069
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Country | US
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Telephone | 407-718-5039
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Fax | 407-331-8597
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT SMITH
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Credential |
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Telephone | 407-718-5039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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