Provider Demographics
NPI:1265638977
Name:ORTHOSTAT, CORP.
Entity Type:Organization
Organization Name:ORTHOSTAT, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:MILAGROS
Authorized Official - Last Name:MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-939-3244
Mailing Address - Street 1:610 SYCAMORE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4984
Mailing Address - Country:US
Mailing Address - Phone:877-606-7846
Mailing Address - Fax:407-816-5893
Practice Address - Street 1:610 SYCAMORE ST STE 130
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4984
Practice Address - Country:US
Practice Address - Phone:877-606-7846
Practice Address - Fax:407-816-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313371332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9302068OtherAETNA
FLM2815OtherBC/BS
FL9302068OtherAETNA
FL9302068OtherAETNA