MEDICARE: OMNICARE MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	ME30256	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073874145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNICARE MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	1805 W COLONIAL DR
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32804-7013
Country	:	US
Telephone Number	:	407-578-9142
Fax Number	:	407-578-8616

Provider Business Practice Location Address
First Line	:	1805 W COLONIAL DR
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32804-7013
Country	:	US
Telephone Number	:	407-578-9142
Fax Number	:	407-578-8616

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	OWEN D FRASER
Credential	:	MD
Telephone Number	:	407-578-9142

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	10/24/2012

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Directions to “OMNICARE MEDICAL CENTER INC ” Practice Location

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