Provider Demographics
NPI:1902353485
Name:BATSON FAMILY HEALTH CENTER FOR WELLNESS,P.A.
Entity Type:Organization
Organization Name:BATSON FAMILY HEALTH CENTER FOR WELLNESS,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-621-1056
Mailing Address - Street 1:450 W STATE ROAD 434
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5118
Mailing Address - Country:US
Mailing Address - Phone:407-331-7079
Mailing Address - Fax:407-331-4233
Practice Address - Street 1:450 W STATE ROAD 434
Practice Address - Street 2:SUITE 2020
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5118
Practice Address - Country:US
Practice Address - Phone:407-331-7079
Practice Address - Fax:407-331-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 46662261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57089Medicare UPIN
FL59981VMedicare PIN