Provider Demographics
NPI:1184832289
Name:CHRISTIAN ORTHOPEDIC MEDICAL CENTER
Entity Type:Organization
Organization Name:CHRISTIAN ORTHOPEDIC MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RHODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-363-7627
Mailing Address - Street 1:6512 CARRIER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8200
Mailing Address - Country:US
Mailing Address - Phone:407-363-7627
Mailing Address - Fax:407-363-7657
Practice Address - Street 1:6512 CARRIER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8200
Practice Address - Country:US
Practice Address - Phone:407-363-7627
Practice Address - Fax:407-363-7657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN