MEDICARE: HIGHLAND CENTER FOR ORTHOPEDICS & UPPER EXTREMITY SURGERY P A

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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	ME70116	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10D2004874	OTHER	FL	CLIA LICENSE FOR 3317 US HWY 98 SOUTH STE 9
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417943846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND CENTER FOR ORTHOPEDICS & UPPER EXTREMITY SURGERY P A

Provider Business Mailing Address
First Line	:	3317 US HIGHWAY 98 S STE 9
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-8316
Country	:	US
Telephone Number	:	863-709-8777
Fax Number	:	863-709-1060

Provider Business Practice Location Address
First Line	:	3317 US HIGHWAY 98 S STE 9
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-8316
Country	:	US
Telephone Number	:	863-709-8777
Fax Number	:	863-709-1060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN MICHAEL JURBALA
Credential	:	MD
Telephone Number	:	863-709-8777

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	07/11/2024

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Directions to “HIGHLAND CENTER FOR ORTHOPEDICS & UPPER EXTREMITY SURGERY P A ” Practice Location

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