Provider Demographics
NPI:1023601259
Name:ORLANDO FREEDOM MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:ORLANDO FREEDOM MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:REPPY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-636-4100
Mailing Address - Street 1:331 N MAITLAND AVE STE D2
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4755
Mailing Address - Country:US
Mailing Address - Phone:407-636-4100
Mailing Address - Fax:
Practice Address - Street 1:331 N MAITLAND AVE STE D2
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4755
Practice Address - Country:US
Practice Address - Phone:407-636-4100
Practice Address - Fax:407-636-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
716944700OtherOWCP DEPARTMENT OF LABOR