Basic Information
| Provider Information | |||||||||
| NPI: | 1760199855 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAREMAX MEDICAL CENTERS OF CENTRAL FLORIDA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 NW 57TH CT STE 400 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331263292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056498100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2595 W INTERNATIONAL SPEEDWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321141118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862710053 | ||||||||
| FaxNumber: | 3862710054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2022 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | DE VERA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3056498100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CAREMAX MEDICAL CENTERS OF CENTRAL FLORIDA, LLC | ||||||||
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| NPICertificationDate: | 10/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.