MEDICARE: CHARLES L BATSON PA FAMILY

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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CW865	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1427455922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES L BATSON PA FAMILY

Provider Business Mailing Address
First Line	:	450 W SR 434
Second Line	:	#2010
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5118
Country	:	US
Telephone Number	:	407-331-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 W SR 434
Second Line	:	#2010
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5118
Country	:	US
Telephone Number	:	407-331-7010
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	CHARLES BATSON SR.
Credential	:
Telephone Number	:	407-621-1056

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/26/2014

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