Provider Demographics
NPI:1669681904
Name:ORLAND MED THERAP GROUP INC
Entity Type:Organization
Organization Name:ORLAND MED THERAP GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:407-293-7600
Mailing Address - Street 1:3760 N JOHN YOUNG PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-3220
Mailing Address - Country:US
Mailing Address - Phone:407-293-7600
Mailing Address - Fax:407-293-7609
Practice Address - Street 1:3760 N JOHN YOUNG PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-3220
Practice Address - Country:US
Practice Address - Phone:407-293-7600
Practice Address - Fax:407-293-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5917261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service