1770779092 NPI number — ORLANDO ORTHOPAEDIC CENTER MD PA

Table of content: (NPI 1770779092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770779092 NPI number — ORLANDO ORTHOPAEDIC CENTER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLANDO ORTHOPAEDIC CENTER MD PA
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:
6
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:
1770779092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 W. CRYSTAL LAKE STREET
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806-4476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-254-2500
Provider Business Mailing Address Fax Number:
407-423-2789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7350 SANDLAKE COMMONS BLVD
Provider Second Line Business Practice Location Address:
SUITE 3315
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:
407-354-3700
Provider Business Practice Location Address Fax Number:
407-345-1146
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOYCE
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
407-254-2555

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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