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General NPI Number Information
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NPI Number | 1285796052
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Entity Type | Organization
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Legal Business Name | HEALTHNET OF CENTRAL FLORIDA PA
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 1785 GARDEN ST
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City | TITUSVILLE
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State | FL
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Zip | 32796-3221
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Country | US
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Telephone | 321-264-1000
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Fax | 321-264-4228
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Provider Business Mailing Address
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Address Line | PO BOX 3087 1785 GARDEN STREET
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City | TITUSVILLE
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State | FL
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Zip | 32781-3087
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Country | US
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Telephone | 321-264-1000
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Fax | 321-264-4228
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN J LAGERGREN
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Credential | M.D.
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Telephone | 321-264-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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