MEDICARE: PPC UNITED, PA

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	207Q00000X	Family Medicine Physician	ME79384	FL

General Provider Information

NPI Number	:	1487912440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PPC UNITED, PA

Provider Business Mailing Address
First Line	:	8976 CONROY WINDERMERE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3128
Country	:	US
Telephone Number	:	407-876-0073
Fax Number	:	407-876-0078

Provider Business Practice Location Address
First Line	:	8976 CONROY WINDERMERE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3128
Country	:	US
Telephone Number	:	407-876-0073
Fax Number	:	407-876-0078

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. JAMES GREGORY SCELFO
Credential	:	MD
Telephone Number	:	407-876-0073

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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