Omnicare Medical Center Inc

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

ME30256 Issued in FL

Legal business name

OMNICARE MEDICAL CENTER INC

Practice address

1805 W Colonial Dr
Suite a
Orlando, FL 32804-7013

Phone

(407) 578-9142

Fax

(407) 578-8616

NPI assigned

Jun 5, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Owen D Fraser, MD

Title

Physician/Owner

Phone

(407) 578-9142

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351036800000",
    "number": "1073874145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 W COLONIAL DR",
            "address_2": "SUITE A",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328047013",
            "telephone_number": "407-578-9142",
            "fax_number": "407-578-8616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 W COLONIAL DR",
            "address_2": "SUITE A",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328047013",
            "telephone_number": "407-578-9142",
            "fax_number": "407-578-8616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNICARE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-05",
        "last_updated": "2012-10-24",
        "status": "A",
        "authorized_official_last_name": "FRASER",
        "authorized_official_first_name": "OWEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "407-578-9142",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "ME30256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "58757500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Omt Healthcare Services LLC
• On Site Medical Services
• On Site Medical Services, Inc

• Medical Specialty Clinic/Center in Orlando, FL
• Providers in Orlando, FL by specialty
• Medical Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.