NPIMap

Organization Active NPI

Medical Home Alliance LLC

Doing business as IMA Winter Haven Dispensary

  • Non-Pharmacy Dispensing Site
  • Winter Haven, FL
National Provider Identifier
1033648233
Registry record updated Jun 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
MEDICAL HOME ALLIANCE LLC
Doing business as
IMA Winter Haven Dispensary
Practice address
199 Avenue K SE
Winter Haven, FL 33880-4002
Phone
(863) 299-6700
Fax
(863) 293-6359
NPI assigned
Jun 9, 2017
Last updated
Jun 13, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
INHEALTH MD ALLIANCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Patricia Pichardo
Title
Coo
Phone
(407) 845-0330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X NU Primary

Addresses

Primary practice location

199 Avenue K SE
Winter Haven, FL 33880-4002

Mailing address

6675 Westwood Blvd Ste 475
Orlando, FL 32821-6027
Phone (407) 845-0330

Other names 1

  • IMA Winter Haven Dispensary Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medical Home Alliance LLC37 organizations share this tax ID, including this one
Part of
Medical Home Alliance LLC

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 144

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 144

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497312000000",
    "number": "1033648233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6675 WESTWOOD BLVD STE 475",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328216027",
            "telephone_number": "407-845-0330",
            "fax_number": "888-972-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 AVENUE K SE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804002",
            "telephone_number": "863-299-6700",
            "fax_number": "863-293-6359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL HOME ALLIANCE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INHEALTH MD ALLIANCE",
        "enumeration_date": "2017-06-09",
        "last_updated": "2017-06-13",
        "status": "A",
        "authorized_official_last_name": "PICHARDO",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "407-845-0330"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMA Winter Haven Dispensary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winter Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.