1033392998 NPI number — ORLANDO HEALTH INC

Table of content: (NPI 1033392998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033392998 NPI number — ORLANDO HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLANDO HEALTH INC
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:
Provider Other Organization Name Type Code:
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:
1033392998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 W. PINELOCH AVE.
Provider Second Line Business Mailing Address:
SUITE 23
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-481-7174
Provider Business Mailing Address Fax Number:
407-481-7190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9430 TURKEY LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-370-8705
Provider Business Practice Location Address Fax Number:
407-370-8732
Provider Enumeration Date:
12/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EGGERT
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
321-841-5111

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 376075803 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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