Healthcare Provider Details

I. General information

NPI: 1316373863
Provider Name (Legal Business Name): GREATER ORLANDO OUTPATIENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N DEAN RD SUITE 101
ORLANDO FL
32825-3710
US

IV. Provider business mailing address

1245 W FAIRBANKS AVE SUITE 350
WINTER PARK FL
32789-7111
US

V. Phone/Fax

Practice location:
  • Phone: 407-963-0811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NOEMI MADERA
Title or Position: CLINICAL ADMINISTRATOR ASSISTANT
Credential:
Phone: 954-532-6418