| Ebenezer Medical Center Orlando Corp. | |
|
845 E Oak Street Kissimmee FL 34744-5838 | |
| (407) 343-1278 | |
| (888) 498-3604 |
| Full Name | Ebenezer Medical Center Orlando Corp. |
|---|---|
| Speciality | General Practice |
| Location | 845 E Oak Street, Kissimmee, Florida |
| Authorized Official Name and Position | Maite Jimenez (OWNER) |
| Authorized Official Contact | 3054913969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebenezer Medical Center Orlando Corp. 845 E Oak Street Kissimmee FL 34744-5838 Ph: (407) 343-1278 | Ebenezer Medical Center Orlando Corp. 845 E Oak Street Kissimmee FL 34744-5838 Ph: (407) 343-1278 |
| NPI Number | 1265178131 |
|---|---|
| Provider Enumeration Date | 05/12/2022 |
| Last Update Date | 01/24/2023 |
| Medicare PECOS PAC ID | 8426424292 |
|---|---|
| Medicare Enrollment ID | O20221019001287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265178131 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Souheil Moussly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063524577 PECOS PAC ID: 5496717787 Enrollment ID: I20100623000459 |
| Provider Name | Daniel Rafael Herrera Infante |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316416340 PECOS PAC ID: 0345582714 Enrollment ID: I20190506000293 |
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