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General NPI Number Information
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NPI Number | 1588312607
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Entity Type | Organization
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Legal Business Name | JEWETT ORTHOPEDIC INSTITUTE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 60 COLUMBIA STREET
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City | ORLANDO
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State | FL
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Zip | 32806
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Country | US
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Telephone | 757-677-6054
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Fax |
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Provider Business Mailing Address
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Address Line | 65 STURTEVANT ST # MP65
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City | ORLANDO
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State | FL
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Zip | 32806-2016
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Country | US
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Telephone | 321-841-8199
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JAN LESLIE DIEDRICH
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Credential |
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Telephone | 321-841-8199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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