OrganizationOrange Park Medical Group, A Professional Corp.SpecialistOther Service ProvidersPractice Address2500 E Ball Rd Ste 200, Anaheim, CA 92806(714) 284-0111PECOS EnrollmentBased on the most recent information from CMS, provider Orange Park Medical Group, A Professional Corp. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1124369715Provider TypeOrganizationFull NameOrange Park Medical Group, A Professional Corp.SubpartNoEnumeration Date3/7/2013Last Updated3/12/2013Contact InformationPractice LocationPractice Address2500 E Ball Rd Ste 200, Anaheim, CA 92806Phone(714) 284-0111Fax(714) 284-0433Mailing LocationMailing Address2500 E Ball Rd Ste 200, Anaheim, CA 92806-5063Phone(714) 284-0111Fax(714) 284-0433Authorized OfficialNameAhmed, Ghazala (Secretary)Phone(714) 284-0111Provider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicenseBUS2010-02745California