NPI |
1346212743 |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Entity Type Code |
2 |
The city name in the location address of the provider being identified. |
Employer Identification Number EIN |
|
The State code in the location of the provider
being identified. |
Provider Organization Name Legal Business Name |
FIRST RESPONSE ORTHOPAEDIC GROUP INC |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider First Line Business Practice Location Address |
2501 N ORANGE AVE |
The country code in the location address of the provider being identified. |
Provider Second Line Business Practice Location Address |
SUITE 340 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address City Name |
ORLANDO |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address State Name |
FL |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Postal Code |
328044603 |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address Telephone Number |
4078958890 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Fax Number |
4078953608 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Enumeration Date |
2/2/2006 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Last Update Date |
8/22/2020 |
|
Authorized Official Last Name |
COLE |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Authorized Official First Name |
DEBBIE |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Authorized Official Title or Position |
OWNER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
4078958890 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
363A00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
X |
|
Healthcare Provider Taxonomy Code 2 |
363L00000X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
X |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MRS. |
|
Healthcare Provider Taxonomy Group 1 |
193400000X MULTIPLE SINGLE SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 2 |
193400000X MULTIPLE SINGLE SPECIALTY GROUP |
|