1174685044 NPI number — CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE

Table of content: (NPI 1174685044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174685044 NPI number — CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE
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:
6
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:
1174685044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1525 TAMIAMI TRL S
Provider Second Line Business Mailing Address:
STE 602
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34285-3568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-497-2663
Provider Business Mailing Address Fax Number:
941-497-5960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 TAMIAMI TRL S
Provider Second Line Business Practice Location Address:
STE 602
Provider Business Practice Location Address City Name:
VENICE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34285-3568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-497-2663
Provider Business Practice Location Address Fax Number:
941-497-5960
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEHSERLE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
941-497-2663

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CB6554 . This is a "RAILROAD MEDICARE GRP PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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