Provider Demographics
NPI:1023160991
Name:OREX MEDICAL CENTER CORPORATION
Entity type:Organization
Organization Name:OREX MEDICAL CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-556-4235
Mailing Address - Street 1:4980 W 10TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3437
Mailing Address - Country:US
Mailing Address - Phone:305-556-4235
Mailing Address - Fax:305-556-4237
Practice Address - Street 1:4980 W 10TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3437
Practice Address - Country:US
Practice Address - Phone:305-556-4235
Practice Address - Fax:305-556-4237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66369208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373393902Medicaid
FLK2118Medicare PIN