Healthcare Provider Details

I. General information

NPI: 1013976422
Provider Name (Legal Business Name): SARASOTA ORTHOPEDIC ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/03/2024
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 PINEBROOK RD STE 201
NOKOMIS FL
34275-3745
US

IV. Provider business mailing address

5741 BEE RIDGE RD STE 400
SARASOTA FL
34233-5062
US

V. Phone/Fax

Practice location:
  • Phone: 941-552-3318
  • Fax:
Mailing address:
  • Phone: 941-951-2663
  • Fax: 941-957-4437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY BURKETT MATHER
Title or Position: CFO
Credential: CPA
Phone: 941-552-3318