| Maitland Family Practice | |
|
402 Lake Howell Rd Maitland FL 32751-5907 | |
| (407) 628-4312 | |
| (407) 628-1845 |
| Full Name | Maitland Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 402 Lake Howell Rd, Maitland, Florida |
| Authorized Official Name and Position | Eddie C Waldheim (PRESIDENT) |
| Authorized Official Contact | 4076284312 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maitland Family Practice 402 Lake Howell Rd Maitland FL 32751-5907 Ph: (407) 628-4312 | Maitland Family Practice 402 Lake Howell Rd Maitland FL 32751-5907 Ph: (407) 628-4312 |
| NPI Number | 1558464669 |
|---|---|
| Provider Enumeration Date | 09/06/2006 |
| Last Update Date | 09/23/2016 |
| Medicare PECOS PAC ID | 5597889139 |
|---|---|
| Medicare Enrollment ID | O20100902000796 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558464669 | NPI | - | NPPES |
| 265582900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Eddie Waldheim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881797082 PECOS PAC ID: 3476678962 Enrollment ID: I20100921001127 |
| Provider Name | Timothy Pursley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376646562 PECOS PAC ID: 5294804670 Enrollment ID: I20100921001241 |
| Provider Name | Jennifer L Sams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295395135 PECOS PAC ID: 3072843259 Enrollment ID: I20191002000158 |
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