| Semoran Family Health, Llc | |
|
632 N Semoran Blvd Orlando FL 32807-3330 | |
| (407) 205-3132 | |
| Not Available |
| Full Name | Semoran Family Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 632 N Semoran Blvd, Orlando, Florida |
| Authorized Official Name and Position | Ronald C Mallonee (PRESIDENT) |
| Authorized Official Contact | 4074928950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Semoran Family Health, Llc 632 N Semoran Blvd Orlando FL 32807-3330 Ph: (407) 205-3132 | Semoran Family Health, Llc 632 N Semoran Blvd Orlando FL 32807-3330 Ph: (407) 205-3132 |
| NPI Number | 1760818488 |
|---|---|
| Provider Enumeration Date | 09/26/2013 |
| Last Update Date | 09/26/2013 |
| Medicare PECOS PAC ID | 2668606054 |
|---|---|
| Medicare Enrollment ID | O20131018001189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760818488 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | OS6833 (Florida) | Primary |
| Provider Name | Ronald C Mallonee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417989633 PECOS PAC ID: 2466424676 Enrollment ID: I20081211000338 |
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