1730207390 NPI number — ORLANDO INTERNAL MEDICINE CLNTER

Table of content: (NPI 1730207390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730207390 NPI number — ORLANDO INTERNAL MEDICINE CLNTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLANDO INTERNAL MEDICINE CLNTER
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:
1730207390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1315 S ORANGE AVE
Provider Second Line Business Mailing Address:
SUITE 3A
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806-2145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-423-4680
Provider Business Mailing Address Fax Number:
407-841-7669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 S ORANGE AVE
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-423-4680
Provider Business Practice Location Address Fax Number:
407-841-7669
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCALL
Authorized Official First Name:
LANA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
407-423-4680

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: 039919100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com