1982788071 NPI number — ORTHOPAEDIC SURGERY CENTER OF CLEARWATER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982788071 NPI number — ORTHOPAEDIC SURGERY CENTER OF CLEARWATER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC SURGERY CENTER OF CLEARWATER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORTHOPAEDIC SURGERY CENTER OF CLEARWATER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982788071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 JEFFORDS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-448-0822
Provider Business Mailing Address Fax Number:
727-447-7044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 JEFFORDS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-448-0822
Provider Business Practice Location Address Fax Number:
727-447-7044
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF NURSING
Authorized Official Telephone Number:
727-448-0822

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  1122 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7544268 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 075143000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2602599 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 490005251 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1122 . This is a "STATE LIC." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 69H . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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