Basic Information
| Provider Information | |||||||||
| NPI: | 1447547344 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORLANDO MSO, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 WEST OAKLAND PARK BOULEVARD | ||||||||
| Address2: | SUITE E 214 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333516741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543186590 | ||||||||
| FaxNumber: | 9543186599 | ||||||||
| Practice Location | |||||||||
| Address1: | 7800 WEST OAKLAND PARK BOULEVARD | ||||||||
| Address2: | SUITE E 214 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333516741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543186590 | ||||||||
| FaxNumber: | 9543186599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2011 | ||||||||
| LastUpdateDate: | 06/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | DI CAPUA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9543186590 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | Y | Managed Care Organizations | Health Maintenance Organization |
No ID Information.