MEDICARE: THE CHILDRENS CENTER 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	2080P0206X	Pediatric Gastroenterology Physician	ME66349	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25816	OTHER	FL	BCBSFL
2	5223945015	OTHER	FL	CIGNA HMO

General Provider Information

NPI Number	:	1902063456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHILDRENS CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 522468
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32752-2468
Country	:	US
Telephone Number	:	407-389-5300
Fax Number	:	407-389-5363

Provider Business Practice Location Address
First Line	:	719 RODEL CV
Second Line	:	SUITE 2001
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5716
Country	:	US
Telephone Number	:	407-351-0804
Fax Number	:	321-203-4605

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENNIS J. BUHRING
Credential	:
Telephone Number	:	407-649-7401

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	12/15/2016

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Directions to “THE CHILDRENS CENTER LLC ” Practice Location

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