Provider Demographics
NPI:1548273139
Name:MAINSTREET MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:MAINSTREET MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAUCHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-348-0990
Mailing Address - Street 1:8723 INTERNATIONAL DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9337
Mailing Address - Country:US
Mailing Address - Phone:407-370-4881
Mailing Address - Fax:407-370-4867
Practice Address - Street 1:8723 INTERNATIONAL DR
Practice Address - Street 2:SUITE 115
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9337
Practice Address - Country:US
Practice Address - Phone:407-370-4881
Practice Address - Fax:407-370-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Not Answered261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine