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NPI Code Detail

MEDICARE: OSCEOLA MEDICLINIC

MEDICARE: OSCEOLA MEDICLINIC
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
1261QU0200XUrgent Care Clinic/CenterME 93125FL

General Provider Information

NPI Number : 1932412368
Entity Type Code : Organization
Provider Name (Legal Business Name) : OSCEOLA MEDICLINIC
Provider Business Mailing Address
First Line : 2497 TRAFALGAR BLVD
Second Line :
City : KISSIMMEE
State : FL
Zip : 34758-2551
Country : US
Telephone Number : 407-350-4844
Fax Number : 407-350-4839
Provider Business Practice Location Address
First Line : 2497 TRAFALGAR BLVD
Second Line :
City : KISSIMMEE
State : FL
Zip : 34758-2551
Country : US
Telephone Number : 407-350-4844
Fax Number : 407-350-4839
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. CAROL R GRANT
Credential : M.D.
Telephone Number : 407-350-4844
Provider Enumeration Date : 07/14/2010
Last Update Date : 03/13/2012

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Directions to “OSCEOLA MEDICLINIC ” Practice Location

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