MEDICARE: CH AFFILIATES, 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	261QU0200X	Urgent Care Clinic/Center		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437644325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CH AFFILIATES, LLC

Provider Business Mailing Address
First Line	:	5833 S GOLDENROD RD STE 5C&D
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8777
Country	:	US
Telephone Number	:	407-810-8777
Fax Number	:	407-658-0721

Provider Business Practice Location Address
First Line	:	5833 S GOLDENROD RD STE 5C&D
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8777
Country	:	US
Telephone Number	:	843-345-2168
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/PA-C
Name	:	DR. WAYNE ELLIS HALL
Credential	:	DHSC, PA-C
Telephone Number	:	843-345-2168

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	09/14/2022

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