1174929269 NPI number — SEMINOLE ORTHOPEDIC & SPINE INSTITUTE, 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 1174929269 NPI number — SEMINOLE ORTHOPEDIC & SPINE INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEMINOLE ORTHOPEDIC & SPINE INSTITUTE, 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:
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:
1174929269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E MONUMENT AVE
Provider Second Line Business Mailing Address:
SUITE#515
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-477-4566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 E MONUMENT AVE
Provider Second Line Business Practice Location Address:
SUITE#515
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-5762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-477-4566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
JUNAID
Authorized Official Middle Name:
Authorized Official Title or Position:
MGRM
Authorized Official Telephone Number:
407-342-6325

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  ME98453 , 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)





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