Provider Demographics
NPI:1891051249
Name:AMANA MEDICAL CENTER, P.A.
Entity type:Organization
Organization Name:AMANA MEDICAL CENTER, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABUSUWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-765-7065
Mailing Address - Street 1:220 ALAFAYA WOODS BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6212
Mailing Address - Country:US
Mailing Address - Phone:321-765-7065
Mailing Address - Fax:321-765-7061
Practice Address - Street 1:220 ALAFAYA WOODS BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6212
Practice Address - Country:US
Practice Address - Phone:321-765-7065
Practice Address - Fax:321-765-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87949207Q00000X, 261QU0200X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023370100Medicaid
FLGF041AOtherMEDICARE GROUP PROVIDER NO
FL0033BOtherBCBS
FLB904LOtherBCBS