Provider Demographics
NPI:1174730303
Name:BUENA VISTA CONCESSIONS, INC
Entity type:Organization
Organization Name:BUENA VISTA CONCESSIONS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-718-5039
Mailing Address - Street 1:940 MOSS TREE PL
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4069
Mailing Address - Country:US
Mailing Address - Phone:407-718-5039
Mailing Address - Fax:407-331-8597
Practice Address - Street 1:2697 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3348
Practice Address - Country:US
Practice Address - Phone:407-938-0349
Practice Address - Fax:407-331-8597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies