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General NPI Number Information
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NPI Number | 1558629527
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY ORTHOPAEDIC CENTER, PA
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 765 HWY 466
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City | LADY LAKE
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State | FL
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Zip | 32159-6340
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Country | US
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Telephone | 352-753-9105
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Fax | 352-753-5280
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Provider Business Mailing Address
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Address Line | 765 HWY 466
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City | LADY LAKE
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State | FL
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Zip | 32159-6340
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Country | US
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Telephone | 352-753-9105
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Fax | 352-753-5280
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY MANDUME KERINA
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Credential | M.D.
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Telephone | 352-326-8115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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