Medicaid Providers Network, LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

ME85696 Issued in FL

Legal business name

MEDICAID PROVIDERS NETWORK, LLC

Practice address

2840 N Hiawassee Rd
428
Orlando, FL 32818-3319

Phone

(407) 921-2074

Fax

(407) 264-8686

NPI assigned

Jun 12, 2013

Organization subpart

No

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

Authorized official

Name

Jasvendar Singh Nandra, M.D.

Title

Ceo

Phone

(407) 921-2074

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370995200000",
    "number": "1710325709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 951659",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327951659",
            "telephone_number": "407-921-2074",
            "fax_number": "407-264-8686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2840 N HIAWASSEE RD",
            "address_2": "428",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328183319",
            "telephone_number": "407-921-2074",
            "fax_number": "407-264-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAID PROVIDERS NETWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-12",
        "last_updated": "2013-06-12",
        "status": "A",
        "authorized_official_last_name": "NANDRA",
        "authorized_official_first_name": "JASVENDAR",
        "authorized_official_middle_name": "SINGH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-921-2074",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "FL",
            "license": "ME85696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Orlando, FL
• Providers in Orlando, FL by specialty
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; 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.