1134661309 NPI number — ADVANCED ORTHOPEDICS INSTITUTE, P.A.

Table of content: (NPI 1134661309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134661309 NPI number — ADVANCED ORTHOPEDICS INSTITUTE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED ORTHOPEDICS INSTITUTE, P.A.
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:
Provider Other Organization Name Type Code:
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:
1134661309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 N US HIGHWAY 441 STE 552
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE VILLAGES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32159-8987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-751-2862
Provider Business Mailing Address Fax Number:
352-751-5541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 N US HIGHWAY 441
Provider Second Line Business Practice Location Address:
SHARON MORSE MEDICAL OFFICE BUILDING, SUITE 552
Provider Business Practice Location Address City Name:
THE VILLAGES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32159-8975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-751-2862
Provider Business Practice Location Address Fax Number:
352-751-5541
Provider Enumeration Date:
11/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN/PARTNER
Authorized Official Telephone Number:
215-696-1283

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME109839 , 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: 002036900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861650145 . This is a "NPPES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003708700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1790745164 . This is a "NPPES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 019677000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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