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General NPI Number Information
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NPI Number | 1316373863
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Entity Type | Organization
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Legal Business Name | GREATER ORLANDO OUTPATIENT CENTER
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 100 N DEAN RD SUITE 101
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City | ORLANDO
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State | FL
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Zip | 32825-3710
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Country | US
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Telephone | 407-963-0811
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 W FAIRBANKS AVE SUITE 350
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City | WINTER PARK
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State | FL
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Zip | 32789-7111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL ADMINISTRATOR ASSISTANT
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Name | NOEMI MADERA
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Credential |
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Telephone | 954-532-6418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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