NPIMap

Organization Active NPI

Chuluota Clinic, LLC

  • Primary Care Clinic/Center
  • Chuluota, FL
National Provider Identifier
1508119637
Registry record updated Oct 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
182428 Issued in FL
Legal business name
CHULUOTA CLINIC, LLC
Practice address
107 8TH St W
Chuluota, FL 32766-8924
Phone
(407) 542-7961
NPI assigned
Oct 26, 2012
Last updated
Oct 26, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2012

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

Authorized official

Name
Michael George Pruner, ARNPNPI 1356472161
Title
Owner
Phone
(407) 542-7961

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 182428 FL Primary

Addresses

Primary practice location

107 8TH St W
Chuluota, FL 32766-8924

Mailing address

107 8TH St W
Chuluota, FL 32766-8924
Phone (407) 542-7961

National Provider Directory

National Provider Directory

Locations

107 W 8th St
Chuluota, FL 32766
Phone (407) 542-7961

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": "1351209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351209600000",
    "number": "1508119637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 8TH ST W",
            "city": "CHULUOTA",
            "state": "FL",
            "postal_code": "327668924",
            "telephone_number": "407-542-7961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 8TH ST W",
            "city": "CHULUOTA",
            "state": "FL",
            "postal_code": "327668924",
            "telephone_number": "407-542-7961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHULUOTA CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-26",
        "last_updated": "2012-10-26",
        "status": "A",
        "authorized_official_last_name": "PRUNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-542-7961",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "182428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chuluota, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2012; 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.