Provider Demographics
NPI:1659726388
Name:ORCHID MEDI-CENTER LLC
Entity Type:Organization
Organization Name:ORCHID MEDI-CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:704-999-3557
Mailing Address - Street 1:104 SE LONITA ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3447
Mailing Address - Country:US
Mailing Address - Phone:772-463-2344
Mailing Address - Fax:772-463-9565
Practice Address - Street 1:104 SE LONITA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3447
Practice Address - Country:US
Practice Address - Phone:772-463-2344
Practice Address - Fax:772-463-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service