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	332B00000X	Durable Medical Equipment & Medical Supplies
2	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	72103	OTHER	FL	BCBS OF FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588812168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSCULOSKELETAL INSTITUTE CHARTERED

Provider Business Mailing Address
First Line	:	13020 N TELECOM PKWY
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33637-0925
Country	:	US
Telephone Number	:	813-978-9700
Fax Number	:	813-558-6185

Provider Business Practice Location Address
First Line	:	36413 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1329
Country	:	US
Telephone Number	:	813-677-8418
Fax Number	:

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

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	02/06/2019

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