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NPI Code Detail

MEDICARE: ORLANDO SPORTS MEDICINE GROUP INC

MEDICARE: ORLANDO SPORTS MEDICINE GROUP INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y902TOTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1023129178
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORLANDO SPORTS MEDICINE GROUP INC
Provider Business Mailing Address
First Line : 12780 WATERFORD LAKES PKWY
Second Line : SUITE 115
City : ORLANDO
State : FL
Zip : 32828-4500
Country : US
Telephone Number : 407-207-7188
Fax Number : 407-207-7103
Provider Business Practice Location Address
First Line : 12780 WATERFORD LAKES PKWY
Second Line : SUITE 115
City : ORLANDO
State : FL
Zip : 32828-4500
Country : US
Telephone Number : 407-207-7188
Fax Number : 407-207-7103
Authorized Official
Title or Position : PRESIDENT
Name : MR. ERIC GREENO
Credential : PT
Telephone Number : 407-207-7188
Provider Enumeration Date : 08/31/2006
Last Update Date : 08/19/2008

Similar Medicare Providers

1861494684 — MR. WILLIAM BIAGGI JR. DPT, ATC, LAT
Practice Location Address:
12780 WATERFORD LAKES PKWY , SUITE 115
ORLANDO, FL
32828-4500
Practice Phone: 407-207-7188
Practice Fax: 407-207-7103
1053427336 — MRS. ALLISON HAUGHTON-GREEN M.D.
Practice Location Address:
12780 WATERFORD LAKES PKWY
ORLANDO, FL
32828-4500
Practice Phone: 407-207-0008
Practice Fax: 407-207-4866
1891897732 — MR. PATRICK STEPHEN PABIAN PT
Practice Location Address:
12780 WATERFORD LAKES PKWY , SUITE 115
ORLANDO, FL
32828-4500
Practice Phone: 407-207-7188
Practice Fax: 407-207-7103
1487756268 — MRS. AUDRA ANNE SAVARESE MT
Practice Location Address:
12780 WATERFORD LAKES PKWY , SUITE 115
ORLANDO, FL
32828-4500
Practice Phone: 407-207-7188
Practice Fax: 407-207-7103
1669574331 — MR. ERIC DANIEL GREENO PT
Practice Location Address:
12780 WATERFORD LAKES PKWY , SUITE 115
ORLANDO, FL
32828-4500
Practice Phone: 407-207-7188
Practice Fax: 407-207-7103
1033211677 — MRS. FARRAH GAGE SINCLAIR MT
Practice Location Address:
12780 WATERFORD LAKES PKWY , SUITE 115
ORLANDO, FL
32828-4500
Practice Phone: 407-207-7188
Practice Fax: 407-207-7103

Directions to “ORLANDO SPORTS MEDICINE GROUP INC ” Practice Location

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