Provider Demographics
NPI:1902465610
Name:PRIME HEALTH OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:PRIME HEALTH OF CENTRAL FLORIDA
Other - Org Name:ADVANCED PEDIATRIC GASTROENTEROLOGY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OSMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-274-7519
Mailing Address - Street 1:608 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6834
Mailing Address - Country:US
Mailing Address - Phone:386-271-2273
Mailing Address - Fax:386-271-2274
Practice Address - Street 1:517 HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1493
Practice Address - Country:US
Practice Address - Phone:386-256-4031
Practice Address - Fax:386-256-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty