Healthcare Provider Details

I. General information

NPI: 1073061107
Provider Name (Legal Business Name): FMSG ALL FLORIDA ORTHOPAEDIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 4TH ST N # 4TH
ST PETERSBURG FL
33703-3802
US

IV. Provider business mailing address

4600 4TH ST N # 4TH
ST PETERSBURG FL
33703-3802
US

V. Phone/Fax

Practice location:
  • Phone: 727-527-5272
  • Fax: 727-522-7412
Mailing address:
  • Phone: 727-527-5272
  • Fax: 727-522-7412

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: MANINA BOSWORTH
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 727-369-5046