Provider Demographics
NPI:1306821194
Name:PREMIER OBSTETRICS AND GYNECOLOGY OF ORLANDO, PA
Entity type:Organization
Organization Name:PREMIER OBSTETRICS AND GYNECOLOGY OF ORLANDO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:VAN WERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-397-1212
Mailing Address - Street 1:531 N MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4421
Mailing Address - Country:US
Mailing Address - Phone:321-397-1212
Mailing Address - Fax:321-397-1213
Practice Address - Street 1:531 N MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4421
Practice Address - Country:US
Practice Address - Phone:321-397-1212
Practice Address - Fax:321-397-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty