Basic Information
| Provider Information | |||||||||
| NPI: | 1477766533 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTH NETWORK OF CENTRAL FLORIDA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 N WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | TITUSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327962163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212686111 | ||||||||
| FaxNumber: | 3212686844 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 N WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | TITUSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327962163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212686111 | ||||||||
| FaxNumber: | 3212686844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MANION | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3212686111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.