MEDICARE: CARROLLTON ORTHOPAEDIC CLINIC PC

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
1	3336C0002X	Clinic Pharmacy
2	333600000X	Pharmacy	038964	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2158453	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033579230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARROLLTON ORTHOPAEDIC CLINIC PC

Provider Business Mailing Address
First Line	:	311 PARK PLACE BLVD
Second Line	:	SUITE 500
City	:	CLEARWATER
State	:	FL
Zip	:	33759-4904
Country	:	US
Telephone Number	:	727-755-0693
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 CLINIC AVE STE 101
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-4402
Country	:	US
Telephone Number	:	727-755-0693
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JAMES GILBERT
Credential	:
Telephone Number	:	727-755-0693

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	03/04/2016

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