=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710543210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE ORTHOPAEDIC INSTITUTE, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2019
-----------------------------------------------------
Last Update Date | 05/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2965 SE 3RD CT
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-0419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-336-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4500 W NEWBERRY RD
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32607-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-336-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MICHAEL A ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-336-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------