Provider Demographics
NPI:1891711180
Name:ORLANDO INFECTIOUS DISEASE CENTER, P.A,
Entity Type:Organization
Organization Name:ORLANDO INFECTIOUS DISEASE CENTER, P.A,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-999-5225
Mailing Address - Street 1:4711 CURRY FORD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-2704
Mailing Address - Country:US
Mailing Address - Phone:407-999-5225
Mailing Address - Fax:407-999-5226
Practice Address - Street 1:4711 CURRY FORD RD
Practice Address - Street 2:SUITE C
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2704
Practice Address - Country:US
Practice Address - Phone:407-999-5225
Practice Address - Fax:407-999-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258466200Medicaid
FLK3450Medicare ID - Type Unspecified
FL258466200Medicaid