Provider Demographics
NPI:1932200961
Name:ORLANDO PAIN AND MEDICAL REHABILITATION CENTER ASO
Entity Type:Organization
Organization Name:ORLANDO PAIN AND MEDICAL REHABILITATION CENTER ASO
Other - Org Name:ORLANDO PAIN & MEDICAL REHABILIATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:T
Authorized Official - Last Name:OLIVEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-265-2100
Mailing Address - Street 1:130 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4312
Mailing Address - Country:US
Mailing Address - Phone:407-265-2100
Mailing Address - Fax:407-265-2872
Practice Address - Street 1:130 E ALTAMONTE DR
Practice Address - Street 2:SUITE 1450
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4312
Practice Address - Country:US
Practice Address - Phone:407-265-2100
Practice Address - Fax:407-265-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty