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General NPI Number Information
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NPI Number | 1629610118
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Entity Type | Organization
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Legal Business Name | THE ORTHOPAEDIC INSTITUTE, PA
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 17270 SE 109TH TERRACE RD
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City | SUMMERFIELD
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State | FL
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Zip | 34491-9015
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Country | US
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Telephone | 352-336-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 NEWBERRY RD
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City | GAINESVILLE
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State | FL
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Zip | 32607-2245
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Country | US
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Telephone | 352-336-6000
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JOLIE HERREN
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Credential |
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Telephone | 352-336-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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