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1199 N Orange Ave Orlando FL 32804-6425 | |
| (407) 701-4500 | |
| (407) 270-5900 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1199 N Orange Ave, Orlando, Florida |
| Authorized Official Name and Position | Anita Riggs (OWNER/PRESIDENT) |
| Authorized Official Contact | 4077014500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1199 N Orange Ave Orlando FL 32804-6425 Ph: (407) 701-4500 | 1199 N Orange Ave Orlando FL 32804-6425 Ph: (407) 701-4500 |
| NPI Number | 1215331822 |
|---|---|
| Provider Enumeration Date | 10/13/2014 |
| Last Update Date | 12/18/2020 |
| Certification Date | 12/18/2020 |
| Medicare PECOS PAC ID | 9133559107 |
|---|---|
| Medicare Enrollment ID | O20200415003630 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215331822 | NPI | - | NPPES |
| 0098B | Other | FL | FL BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (Florida) | Primary |
| Provider Name | Scott D Farmer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891733051 PECOS PAC ID: 6709013840 Enrollment ID: I20131216001186 |
| Provider Name | Valencia Sylveus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750896080 PECOS PAC ID: 0840674305 Enrollment ID: I20220901000106 |
| Provider Name | Renuka Velisetty |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740623784 PECOS PAC ID: 8426336272 Enrollment ID: I20240213001345 |
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