Healthcare Provider Details

I. General information

NPI: 1013954635
Provider Name (Legal Business Name): ORLANDO HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W UNDERWOOD ST
ORLANDO FL
32806-1122
US

IV. Provider business mailing address

77 W UNDERWOOD ST
ORLANDO FL
32806-1122
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7970
  • Fax: 321-841-7978
Mailing address:
  • Phone: 321-841-7970
  • Fax: 321-841-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH EGGERT
Title or Position: VP REVENUE MANAGEMENT
Credential:
Phone: 407-237-6393