Healthcare Provider Details

I. General information

NPI: 1427104454
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 SW 32ND PL STE 400
OCALA FL
34471-7866
US

IV. Provider business mailing address

2685 SW 32ND PL STE 400
OCALA FL
34471-7866
US

V. Phone/Fax

Practice location:
  • Phone: 352-624-0004
  • Fax: 352-624-3090
Mailing address:
  • Phone: 352-624-0004
  • Fax: 352-624-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME73474
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT8468
License Number StateFL

VIII. Authorized Official

Name: ANGIE OBHOLZ
Title or Position: BUSINESS MANAGER
Credential:
Phone: 352-624-0004