Provider Demographics
NPI:1568279255
Name:ISA MEDICAL CENTER LLC
Entity type:Organization
Organization Name:ISA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ORIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-280-4611
Mailing Address - Street 1:9350 W US-192 HWY
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9350 W US-192 HWY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897
Practice Address - Country:US
Practice Address - Phone:786-280-6011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center