Basic Information
| Provider Information | |||||||||
| NPI: | 1598087231 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOMEN'S HEALTHCARE OF ORLANDO, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 781444 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328781444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074532072 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3701 AVALON PARK WEST BLVD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328287303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074532072 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2010 | ||||||||
| LastUpdateDate: | 11/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | DUNN | ||||||||
| AuthorizedOfficialFirstName: | INGRID | ||||||||
| AuthorizedOfficialMiddleName: | PATRICIA | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLO PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 4074532072 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | ME 104799 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | CX948Z | 01 | FL | ASSOCIATED INDIVIDUAL MEDICARE NUMBER | OTHER | 002284400 | 01 | FL | INDIVIDUAL MEDICAID NUMBER | OTHER | GROUP CX949A | 01 | FL | GROUP MEDICARE NUMBER | OTHER | 1073735270 | 01 | FL | INDIVIDUAL PROVIDER NPI | OTHER | 001933000 | 01 | FL | GROUP MEDICAID NUMBER | OTHER |