=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801805973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASTRO MEDIC CARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 GOODRICH AVE SUITE B
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-464-2130
-----------------------------------------------------
Fax | 407-464-2156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2209
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32704-2209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-464-2130
-----------------------------------------------------
Fax | 407-464-2156
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROHITAS AGARWAL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 407-464-2130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | ME86430
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------