Healthcare Provider Details
I. General information
NPI: 1295210003
Provider Name (Legal Business Name): ROYAL PALM ORTHOPEDIC & SPORTS MEDICINE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/27/2018
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4040 US HIGHWAY 27 N
SEBRING FL
33870-1320
US
IV. Provider business mailing address
23781 US HIGHWAY 27 STE 122
LAKE WALES FL
33859-7802
US
V. Phone/Fax
- Phone: 863-324-6100
- Fax: 863-679-9182
- Phone: 863-324-6100
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207X00000X |
| Taxonomy | Orthopaedic Surgery Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
DAVID
ARANGO
Title or Position: OWNER
Credential: MD
Phone: 863-324-6100