Provider Demographics
NPI:1538369251
Name:CENTRAL FLORIDA HEALTH CARE INC
Entity type:Organization
Organization Name:CENTRAL FLORIDA HEALTH CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FULSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-452-3060
Mailing Address - Street 1:1729 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3016
Mailing Address - Country:US
Mailing Address - Phone:863-686-0082
Mailing Address - Fax:863-686-2893
Practice Address - Street 1:1729 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3016
Practice Address - Country:US
Practice Address - Phone:863-686-0082
Practice Address - Fax:863-686-2893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL FLORIDA HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77069OtherBLUE CROSS BLUE SHIELD