Medek Provider Network LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MEDEK PROVIDER NETWORK LLC

Practice address

131 Waterman Ave
Mount Dora, FL 32757-9541

Phone

(352) 385-1803

NPI assigned

Jul 22, 2020

Organization subpart

No

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

Authorized official

Name

Eugene Mahfood

Title

Director of Operations

Phone

(954) 892-3940

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625529600000",
    "number": "1356959779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 WATERMAN AVE",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327579541",
            "telephone_number": "352-385-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 WATERMAN AVE",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327579541",
            "telephone_number": "352-385-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDEK PROVIDER NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-22",
        "last_updated": "2021-07-06",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "MAHFOOD",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "954-892-3940"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; 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.