Healthcare Provider Details

I. General information

NPI: 1003687674
Provider Name (Legal Business Name): ESWT ORTHOPEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 NW 13TH ST
GAINESVILLE FL
32601-4137
US

IV. Provider business mailing address

PO BOX 364
WALDO FL
32694-0364
US

V. Phone/Fax

Practice location:
  • Phone: 352-258-5858
  • Fax:
Mailing address:
  • Phone: 877-291-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HARLAN CARTER
Title or Position: OPERATIONS
Credential:
Phone: 352-258-5858