Healthcare Provider Details

I. General information

NPI: 1861761256
Provider Name (Legal Business Name): ORTHOMED PAIN & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 COMMERCIAL CT SUITE D2
VENICE FL
34292-1617
US

IV. Provider business mailing address

4071 BEE RIDGE RD SUITE 101
SARASOTA FL
34233-2550
US

V. Phone/Fax

Practice location:
  • Phone: 941-485-1890
  • Fax: 941-485-1783
Mailing address:
  • Phone: 941-371-7171
  • Fax: 941-371-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS8697
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM J COLE JR.
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 941-485-1890