Healthcare Provider Details

I. General information

NPI: 1811404155
Provider Name (Legal Business Name): THE CENTER FOR BONE AND JOINT DISEASE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16506 POINTE VILLAGE DR STE 109
LUTZ FL
33558-5255
US

IV. Provider business mailing address

7544 JACQUE RD
HUDSON FL
34667-7162
US

V. Phone/Fax

Practice location:
  • Phone: 727-605-3808
  • Fax: 352-503-2361
Mailing address:
  • Phone: 727-697-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GRACE NICOLE MARTINO
Title or Position: BILLING DEPARTMENT
Credential:
Phone: 727-857-4397