Provider Demographics
NPI:1255037677
Name:COMMUNITY MEDICAL CENTER OF ORLANDO
Entity type:Organization
Organization Name:COMMUNITY MEDICAL CENTER OF ORLANDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MULVA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-705-3424
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-0474
Mailing Address - Country:US
Mailing Address - Phone:407-705-3424
Mailing Address - Fax:
Practice Address - Street 1:2295 S HIAWASSEE RD STE 210
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8748
Practice Address - Country:US
Practice Address - Phone:407-705-3424
Practice Address - Fax:321-284-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty