MEDICARE: MEDICAL HOME ALLIANCE 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

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	:	1922775931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL HOME ALLIANCE LLC

Provider Business Mailing Address
First Line	:	6675 WESTWOOD BLVD STE 475
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-6027
Country	:	US
Telephone Number	:	407-845-0330
Fax Number	:	888-972-1752

Provider Business Practice Location Address
First Line	:	4543 PLEASANT HILL RD SPC A
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34759-3406
Country	:	US
Telephone Number	:	407-933-7900
Fax Number	:	321-437-0072

Authorized Official
Title or Position	:	VP REVENUE CYCLE
Name	:	VANESSA HOURIHAN
Credential	:
Telephone Number	:	407-845-0322

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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