| Central Florida Child Health Program | |
|
7040 Lake Ellenor Drive Orlando FL 32809-5750 | |
| (407) 858-6143 | |
| (407) 856-6594 |
| Full Name | Central Florida Child Health Program |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 7040 Lake Ellenor Drive, Orlando, Florida |
| Authorized Official Name and Position | Cathleen O. Mark (PROJECT ADMINISTRATOR) |
| Authorized Official Contact | 4078586143 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Florida Child Health Program 7040 Lake Ellenor Drive Orlando FL 32809-5750 Ph: (407) 858-6143 | Central Florida Child Health Program 7040 Lake Ellenor Drive Orlando FL 32809-5750 Ph: (407) 858-6143 |
| NPI Number | 1376623686 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 04/05/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376623686 | NPI | - | NPPES |
| 056105300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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