1477725992 NPI number — FLORIDA DEPARTMENT OF HEALTH

Table of content: (NPI 1477725992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477725992 NPI number — FLORIDA DEPARTMENT OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA DEPARTMENT OF HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORANGE COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477725992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 LAKE ELLENOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32809-4616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-858-1400
Provider Business Mailing Address Fax Number:
407-858-5514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
832 W CENTRAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32805-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-836-2615
Provider Business Practice Location Address Fax Number:
407-836-7108
Provider Enumeration Date:
03/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VEGA
Authorized Official First Name:
BRUNI
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM MANAGER
Authorized Official Telephone Number:
407-856-1400

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  PH1953 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 027958789 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018351 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 027958707 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com