Pro Health Heritage Square LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME0069080 Issued in FL

Legal business name

PRO HEALTH HERITAGE SQUARE LLC

Practice address

901 E Oak St
Suite a
Kissimmee, FL 34744-5837

Phone

(561) 843-7720

NPI assigned

Jan 2, 2013

Last updated

Apr 4, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joseph J. Dicapua

Title

MGRM

Phone

(561) 843-7720

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1357084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1801132386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 NW 33RD CT",
            "address_2": "SUITE 11",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330691000",
            "telephone_number": "954-586-8058",
            "fax_number": "954-283-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 E OAK ST",
            "address_2": "SUITE A",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347445837",
            "telephone_number": "561-843-7720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO HEALTH HERITAGE SQUARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-02",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "DICAPUA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "MGRM",
        "authorized_official_telephone_number": "561-843-7720"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0069080",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "FL",
            "license": "ME19806",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Kissimmee, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; 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.