MEDICARE: EASTCOAST MEDICAL NETWORK INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QU0200X	Urgent Care Clinic/Center
2	207Q00000X	Family Medicine Physician
3	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1013128420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTCOAST MEDICAL NETWORK INC

Provider Business Mailing Address
First Line	:	6000 TURKEY LAKE RD STE 209
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4206
Country	:	US
Telephone Number	:	407-648-5252
Fax Number	:	407-370-4126

Provider Business Practice Location Address
First Line	:	6000 TURKEY LAKE RD STE 208
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4206
Country	:	US
Telephone Number	:	407-648-5252
Fax Number	:	407-370-4126

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MELISSA J STAFFELLI
Credential	:
Telephone Number	:	407-648-5252

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	08/13/2024

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Directions to “EASTCOAST MEDICAL NETWORK INC ” Practice Location

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