MEDICARE: CHCP SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME 63398	FL

General Provider Information

NPI Number	:	1053701987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHCP SERVICES LLC

Provider Business Mailing Address
First Line	:	1607 E SILVER STAR RD
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2553
Country	:	US
Telephone Number	:	407-522-5858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 E SILVER STAR RD
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2553
Country	:	US
Telephone Number	:	407-522-5858
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARLOS COLOMBO
Credential	:	MD
Telephone Number	:	40752225858

Provider Enumeration Date	:	01/30/2015
Last Update Date	:	01/30/2015

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