NPIMap

Organization Active NPI

Celebrity Medical Center LLC

  • Clinic/Center
  • Winter Garden, FL
National Provider Identifier
1437429073
Registry record updated Dec 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
CELEBRITY MEDICAL CENTER LLC
Practice address
36 S Main St
Winter Garden, FL 34787-3125
Phone
(407) 347-9886
Fax
(407) 387-9887
NPI assigned
Jan 12, 2012
Last updated
Dec 22, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2015

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

Authorized official

Name
Dr. Eldar Bolatovich Baigabatov, M.D.NPI 1104999655
Title
President
Phone
(407) 347-9886

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

36 S Main St
Winter Garden, FL 34787-3125

Mailing address

36 S Main St
Winter Garden, FL 34787-3125
Phone (407) 347-9886

Other identifiers 1

IdentifierTypeStateIssuer
007VROtherFLFL BLUE

Other names 1

  • Celebrity Medical Spa, LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

36 S Main St
Winter Garden, FL 34787
Phone (407) 347-9886

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450742400000",
    "number": "1437429073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 S MAIN ST",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873125",
            "telephone_number": "407-347-9886",
            "fax_number": "407-387-9887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 S MAIN ST",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873125",
            "telephone_number": "407-347-9886",
            "fax_number": "407-387-9887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CELEBRITY MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-12",
        "last_updated": "2015-12-22",
        "status": "A",
        "authorized_official_last_name": "BAIGABATOV",
        "authorized_official_first_name": "ELDAR",
        "authorized_official_middle_name": "BOLATOVICH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-347-9886",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BLUE",
            "identifier": "007VR",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Celebrity Medical Spa, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Winter Garden, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2015; 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.