MEDICARE: MUSCULOSKELETAL INSTITUTE CHARTERED

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1104459874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSCULOSKELETAL INSTITUTE CHARTERED

Provider Business Mailing Address
First Line	:	1901 HAVERFORD AVE STE 107
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5200
Country	:	US
Telephone Number	:	813-633-0286
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 HAVERFORD AVE STE 107
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5200
Country	:	US
Telephone Number	:	813-633-0886
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROY W SANDERS
Credential	:
Telephone Number	:	813-978-9700

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	02/20/2020

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