Organization
CENTRAL FLORIDA MEDICAL ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ILENE BALLENTINE (OFFICE MANAGER)
(386) 774-0401
Entity
Organization
Contact information
Practice address
2555 S VOLUSIA AVE, ORANGE CITY, FL 32763-9135
(386) 774-0401
(386) 774-5783
Mailing address
2555 S VOLUSIA AVE, ORANGE CITY, FL 32763-9135
(386) 774-0401
(386) 774-5783
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME75141
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K2371
MEDICARE PTAN
FL
Enumeration date
01/19/2007
Last updated
01/12/2015
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