NPIMap

Organization Active NPI

Mindful Integrated Medicine LLC

  • General Practice Physician
  • Kissimmee, FL
National Provider Identifier
1831544832
Registry record updated Oct 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MINDFUL INTEGRATED MEDICINE LLC
Practice address
711 E Oak St
Kissimmee, FL 34744-4573
Phone
(407) 846-0533
Fax
(407) 518-1730
NPI assigned
Apr 27, 2016
Last updated
Oct 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2016

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

Authorized official

Name
Ms. Ivette A Charneco
Title
Office Administrator
Phone
(407) 846-0533

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Clinic/Center 261Q00000X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

711 E Oak St
Kissimmee, FL 34744-4573

Mailing address

719 E Oak St
Kissimmee, FL 34744-4580
Phone (407) 846-0533

National Provider Directory

National Provider Directory

Locations

711 E Oak St
Kissimmee, FL 34744
Phone (407) 846-0533

Practitioners & affiliated clinicians

Practitioners 52

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.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1831544832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 E OAK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347444580",
            "telephone_number": "407-846-0533",
            "fax_number": "407-518-1730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 E OAK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347444573",
            "telephone_number": "407-846-0533",
            "fax_number": "407-518-1730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL INTEGRATED MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-27",
        "last_updated": "2016-10-04",
        "status": "A",
        "authorized_official_last_name": "CHARNECO",
        "authorized_official_first_name": "IVETTE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "407-846-0533",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; 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.