MEDICARE: ORANGE CARE MANAGEMENT SERVICES ORGANIZATION LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1902414675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE CARE MANAGEMENT SERVICES ORGANIZATION LLC

Provider Business Mailing Address
First Line	:	14750 NW 77TH CT STE 308
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-1537
Country	:	US
Telephone Number	:	786-363-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	11011 SHERIDAN ST STE 302
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1532
Country	:	US
Telephone Number	:	954-437-1500
Fax Number	:	954-437-0136

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	LISSETTE EXPOSITO
Credential	:
Telephone Number	:	786-363-8500

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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