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General NPI Number Information
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NPI Number | 1639351398
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Entity Type | Organization
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Legal Business Name | ADVANCED ORTHOPEDIC SURGERY OF CELEBRATION, LLC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 250 3RD ST NW SUITE 201
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4605
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Country | US
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Telephone | 863-318-9696
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Fax | 863-318-8075
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Provider Business Mailing Address
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Address Line | PO BOX 490
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City | EAGLE LAKE
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State | FL
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Zip | 33839-0490
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Country | US
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Telephone | 863-318-9696
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Fax | 863-318-8075
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. LARRY R. PADGETT JR.
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Credential | M.D.
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Telephone | 863-318-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME75825
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License Number State | FL
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