=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619127263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL FLORIDA INTERNISTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2008
-----------------------------------------------------
Last Update Date | 09/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3505 PROGRESS LANE
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34769-6519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-957-9911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 700577
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34770-0577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-957-9911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF BUSINESS DEVELOPMENT
-----------------------------------------------------
Name | MS. TABITHA RUBIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-348-5175
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------