Basic Information
| Provider Information | |||||||||
| NPI: | 1669419370 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORLANDO HEALTH INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 89 W COPELAND DR | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078415281 | ||||||||
| FaxNumber: | 4076489879 | ||||||||
| Practice Location | |||||||||
| Address1: | 89 W COPELAND DR | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078415281 | ||||||||
| FaxNumber: | 4076489879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 10/12/2009 | ||||||||
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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 | 2080P0206X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | 2080P0210X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | 207RG0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207VM0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 77559 | 01 | FL | BCBS | OTHER | 8720143 | 01 | FL | AETNA | OTHER | 060985400 | 05 | FL | MEDICAID |