Provider Demographics
NPI:1063434017
Name:MEDICAL ALTERNATIVES OF AMERICA INC
Entity type:Organization
Organization Name:MEDICAL ALTERNATIVES OF AMERICA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-352-1030
Mailing Address - Street 1:5979 VINELAND RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7800
Mailing Address - Country:US
Mailing Address - Phone:407-352-1030
Mailing Address - Fax:407-352-2884
Practice Address - Street 1:5979 VINELAND RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7800
Practice Address - Country:US
Practice Address - Phone:407-352-1030
Practice Address - Fax:407-352-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2617642363LP2300X
FLPA9103647363A00000X
FLME69749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF67953Medicare UPIN
FL6040060001Medicare NSC
FLK7081Medicare ID - Type Unspecified
FL28914YMedicare PIN