Organization
ORLANDO SPORTS MEDICINE GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC GREENO PT (PRESIDENT)
(407) 207-7188
Entity
Organization
Contact information
Practice address
12780 WATERFORD LAKES PKWY, SUITE 115, ORLANDO, FL 32828-4500
(407) 207-7188
(407) 207-7103
Mailing address
12780 WATERFORD LAKES PKWY, SUITE 115, ORLANDO, FL 32828-4500
(407) 207-7188
(407) 207-7103
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y902T
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/31/2006
Last updated
08/19/2008
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