1982788071 NPI number — ORTHOPAEDIC SURGERY CENTER OF CLEARWATER LLC

Table of content: (NPI 1982788071)

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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