Basic Information
| Provider Information | |||||||||
| NPI: | 1487691259 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORLANDO HEALTH INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 818 MAIN LN | ||||||||
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| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328013727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218416600 | ||||||||
| FaxNumber: | 3218414085 | ||||||||
| Practice Location | |||||||||
| Address1: | 818 MAIN LN | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328013727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218416600 | ||||||||
| FaxNumber: | 3218414085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 01/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | EGGERT | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP REVENUE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4072376393 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 77561 | 01 | FL | BCBS OF FLORIDA | OTHER | 000001413C | 01 | FL | HUMANA | OTHER | 060222100 | 05 | FL | MEDICAID |