# MEDICAID PROVIDERS NETWORK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710325709
- **Authorized official:** JASVENDAR SINGH NANDRA M.D. (CEO)
- **Authorized official phone:** (407) 921-2074

## Contact information

- **Practice address:** 2840 N HIAWASSEE RD, 428, ORLANDO, FL 32818-3319
- **Practice address phone:** (407) 921-2074
- **Practice address fax:** (407) 264-8686
- **Mailing address:** PO BOX 951659, LAKE MARY, FL 32795-1659
- **Mailing address phone:** (407) 921-2074
- **Mailing address fax:** (407) 264-8686

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | ME85696 | FL | Yes |

## Other

- **Enumeration date:** 06/12/2013
- **Last updated:** 06/12/2013