Orlando Primary Care Pa | |
6200 Silver Star Rd Orlando FL 32808-4245 | |
(407) 298-0912 | |
(407) 298-1750 |
Full Name | Orlando Primary Care Pa |
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Speciality | Internal Medicine |
Location | 6200 Silver Star Rd, Orlando, Florida |
Authorized Official Name and Position | Venkateswara R Nandam (PRESIDENT) |
Authorized Official Contact | 4072980912 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Orlando Primary Care Pa 6200 Silver Star Rd Orlando FL 32808-4245 Ph: (407) 298-0912 | Orlando Primary Care Pa 6200 Silver Star Rd Orlando FL 32808-4245 Ph: (407) 298-0912 |
NPI Number | 1336328012 |
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Provider Enumeration Date | 10/30/2007 |
Last Update Date | 01/06/2013 |
Medicare PECOS PAC ID | 0143211086 |
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Medicare Enrollment ID | O20040520000295 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336328012 | NPI | - | NPPES |
255449600 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | ME76077 (Florida) | Primary |
Provider Name | Venkateswar Nandam |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1669444626 PECOS PAC ID: 1759372691 Enrollment ID: I20040525000280 |
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