Advanced Medical Group of Central Florida, LLC
Organization Active NPI Gastroenterology Physician · Kissimmee, FL
NPI 1780149120 · NPPES record last updated Aug 26, 2019
Key facts
- NPI
- 1780149120
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- Legal business name
- ADVANCED MEDICAL GROUP OF CENTRAL FLORIDA, LLC
- Practice address
- 1036 Mann St
Kissimmee, FL 34741-4121 - Phone
- (407) 518-7277
- Fax
- (407) 785-3234
- NPI assigned
- Feb 8, 2019
- Organization subpart
- No
Authorized official
- Name
- Vinay Katukuri, MD
- Title
- Owner
- Phone
- (407) 518-7277
Practitioners 2
-
Vinay K Katukuri, MD
-
Neelima Katukuri, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190710002316 | FL | Part B Supplier - Clinic/Group Practice | 9931434131 |
Receives reassigned benefits from 1 practitioner Practice locations: Kissimmee, FL; Orlando, FL |
National Provider Directory
Locations
2275 N Central Ave
Kissimmee, FL 34741
Phone (407) 570-0573
13807 Landstar Blvd
Ste 142
Orlando, FL 32824
Phone (407) 518-7277
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician |
207RG0100X | Yes |
Addresses
Primary practice location
1036 Mann St
Kissimmee, FL 34741-4121
Mailing address
9462 Becker CT
Orlando, FL 32827-4304
Phone (407) 518-7277
Other names
- Advanced Gastroenterology of Central Florida
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All providers in Kissimmee, FL · Gastroenterology 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 Aug 26, 2019. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.