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General NPI Number Information
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NPI Number | 1093249443
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Entity Type | Organization
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Legal Business Name | MUSCULOSKELETAL INSTITUTE CHARTERED
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 2010 59TH ST W SUITE 2200
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City | BRADENTON
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State | FL
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Zip | 34209-4689
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Country | US
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Telephone | 813-978-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 13020 N TELECOM PKWY
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-0925
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Country | US
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Telephone | 813-978-9700
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Fax | 813-558-6185
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROY W SANDERS
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Credential | MD
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Telephone | 813-978-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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