Leavitt Medical Associates of Florida Inc
Organization Active NPI Dermatology Physician · Orlando, FL
NPI 1104084672 · NPPES record last updated Apr 21, 2010
Key facts
- NPI
- 1104084672
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
- Practice address
- 14050 Town Loop Blvd Ste 203
Orlando, FL 32837-6190 - Phone
- (407) 852-6650
- Fax
- (407) 852-6035
- NPI assigned
- May 30, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Authorized official
- Name
- Amy Declue
- Title
- Director, Provider Services
- Phone
- (407) 875-2080
Practitioners 6
-
Bobbie Ferrell, ARNP
-
Rachel Henshaw, ARNP
-
Hannah Leonard, PA-C
-
Chetan Vedvyas, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2282117 | Advanced Dermatology and Cosmetic Surgery | Registration | May 31, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050228000737 | FL | Part B Supplier - Clinic/Group Practice | 4688579311 |
Receives reassigned benefits from 243 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Leavitt Medical Associates of Florida Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes | ||
| Emergency Medicine Physician |
207P00000X | |||
| Plastic Surgery Physician |
208200000X |
Addresses
Primary practice location
14050 Town Loop Blvd Ste 203
Orlando, FL 32837-6190
Mailing address
2600 Lake Lucien Dr Ste 180
Maitland, FL 32751-7235
Phone (407) 875-2080
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 256877206 | Medicaid | FL |
Other names
- Advanced Dermatology and Cosmetic Surgery
Other providers in Orlando, FL
- Morgan Patricia Leary
- Ryan Leary
- Valerie Deshawn Leath
- Jessica Leather
- Lina Esmeraldo Leavens
- Leavitt Medical Associates of Florida Inc
- Leavitt Medical Associates of Florida Inc
- Leavitt Medical Associates of Florida Inc
- Anna Leavitt
- Debra Anne Leavitt
All providers in Orlando, FL · Dermatology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.