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General NPI Number Information
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NPI Number | 1285812362
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Entity Type | Organization
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Legal Business Name | MAITLAND AVENUE URGENT CARE PA
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 411 MAITLAND AVE STE 1002
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5448
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Country | US
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Telephone | 321-207-0002
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Fax | 321-207-2003
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Provider Business Mailing Address
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Address Line | 411 MAITLAND AVE SUITE 1002
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5448
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Country | US
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Telephone | 321-207-0002
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Fax | 321-207-0003
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Authorized Official
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Title or Position | PRESIDENT
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Name | SETH T JOHNSON
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Credential | D.O.
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Telephone | 321-207-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | OS5330
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License Number State | FL
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