| Living Florida Healthcare Llc | |
|
4804 Edgewater Dr Orlando FL 32804-1126 | |
| (321) 330-9330 | |
| (321) 697-7000 |
| Full Name | Living Florida Healthcare Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4804 Edgewater Dr, Orlando, Florida |
| Authorized Official Name and Position | Tom Anthony Harris (ADMINISTRATOR) |
| Authorized Official Contact | 4075742121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Florida Healthcare Llc 4804 Edgewater Dr Ste A Orlando FL 32804-1126 Ph: (407) 574-2121 | Living Florida Healthcare Llc 4804 Edgewater Dr Orlando FL 32804-1126 Ph: (321) 330-9330 |
| NPI Number | 1073006631 |
|---|---|
| Provider Enumeration Date | 06/08/2018 |
| Last Update Date | 10/19/2022 |
| Medicare PECOS PAC ID | 2365787439 |
|---|---|
| Medicare Enrollment ID | O20181218000703 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073006631 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Richard B Powell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023103702 PECOS PAC ID: 9830157981 Enrollment ID: I20041222000201 |
| Provider Name | Marlene V Lindsay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336163823 PECOS PAC ID: 5799709721 Enrollment ID: I20060118000148 |
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