MEDICARE: CLEARWATER ORTHOPEDIC & SPORTS MEDICINE 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
1	207X00000X	Orthopaedic Surgery Physician	OS0006819	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1306041421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARWATER ORTHOPEDIC & SPORTS MEDICINE INC

Provider Business Mailing Address
First Line	:	701 N HERCULES AVE STE A
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-2029
Country	:	US
Telephone Number	:	727-562-9317
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 N HERCULES AVE STE A
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-2029
Country	:	US
Telephone Number	:	727-562-9317
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN NICHOLAS HARKER
Credential	:	DO
Telephone Number	:	727-562-9317

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	02/22/2008

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