Provider Demographics
NPI:1871558973
Name:MEDICAL VILLAGE HOLDINGS INC
Entity type:Organization
Organization Name:MEDICAL VILLAGE HOLDINGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-662-3821
Mailing Address - Street 1:816 W OAK STREET
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741
Mailing Address - Country:US
Mailing Address - Phone:407-944-9777
Mailing Address - Fax:407-944-9796
Practice Address - Street 1:1462 W OAK RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809
Practice Address - Country:US
Practice Address - Phone:407-770-0078
Practice Address - Fax:407-888-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care