=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669419370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORLANDO HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 10/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 89 W COPELAND DR 1ST FLOOR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-841-5281
-----------------------------------------------------
Fax | 407-648-9879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 89 W COPELAND DR 1ST FLOOR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-841-5281
-----------------------------------------------------
Fax | 407-648-9879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP REVENUE MANAGEMENT
-----------------------------------------------------
Name | KEITH EGGERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-237-6393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0206X
-----------------------------------------------------
Taxonomy Name | Pediatric Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0210X
-----------------------------------------------------
Taxonomy Name | Pediatric Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207VM0101X
-----------------------------------------------------
Taxonomy Name | Maternal & Fetal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------