Healthcare Provider Details

I. General information

NPI: 1508499302
Provider Name (Legal Business Name): MUSCULOSKELETAL INSTITUTE CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2044 TRINITY OAKS BLVD STE 110
TRINITY FL
34655-4405
US

IV. Provider business mailing address

2044 TRINITY OAKS BLVD STE 110
TRINITY FL
34655-4405
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-6026
  • Fax:
Mailing address:
  • Phone:
  • 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: ROY W SANDERS
Title or Position: PRESIDENT
Credential:
Phone: 813-978-9700