MEDICARE: ORLANDO VA HEALTHCARE CENTER

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1295956555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO VA HEALTHCARE CENTER

Provider Business Mailing Address
First Line	:	1228 WEST AVE
Second Line	:	APT 1009
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-4381
Country	:	US
Telephone Number	:	407-452-8938
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 WEST AVE
Second Line	:	APT 1009
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-4381
Country	:	US
Telephone Number	:	407-452-8938
Fax Number	:

Authorized Official
Title or Position	:	ORTHOTIST
Name	:	MR. TERRENCE CHARLES O'CONNOR JR.
Credential	:
Telephone Number	:	321-397-6117

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	08/22/2020

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