Provider Demographics
NPI:1659724441
Name:FLORIDA ORTHO ER LLC
Entity Type:Organization
Organization Name:FLORIDA ORTHO ER LLC
Other - Org Name:ORTHONOW OVIEDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN CARLOS
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-747-7236
Mailing Address - Street 1:1536 PLANTATION POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4840
Mailing Address - Country:US
Mailing Address - Phone:407-747-7236
Mailing Address - Fax:
Practice Address - Street 1:3607 ALOMA AVE STE 1081
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8856
Practice Address - Country:US
Practice Address - Phone:407-747-7236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care