1831744549 NPI number — ORLES PAIN MANAGEMENT & REGENERATIVE MEDICINE GRP

Table of content: (NPI 1831744549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831744549 NPI number — ORLES PAIN MANAGEMENT & REGENERATIVE MEDICINE GRP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLES PAIN MANAGEMENT & REGENERATIVE MEDICINE GRP
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:
1831744549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 UNIVERSITY BLVD S
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-2752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-274-8813
Provider Business Mailing Address Fax Number:
904-503-4465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 UNIVERSITY BLVD S
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-274-8813
Provider Business Practice Location Address Fax Number:
904-503-4465
Provider Enumeration Date:
08/08/2019

Additional Information

Authorized Official

Authorized Official Last Name:
FLORETE
Authorized Official First Name:
ORLANDO
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MEDICAL DIRECTOR/OWNER
Authorized Official Telephone Number:
904-274-8813

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103992600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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